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. 2017 Jul;13(3):227-233.
doi: 10.3988/jcn.2017.13.3.227.

Neurological Complications during Treatment of Middle East Respiratory Syndrome

Jee Eun Kim  1 , Jae Hyeok Heo  2 , Hye Ok Kim  3 , Sook Hee Song  3 , Sang Soon Park  2 , Tai Hwan Park  2 , Jin Young Ahn  2 , Min Ky Kim  2 , Jae Phil Choi  4
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Neurological Complications during Treatment of Middle East Respiratory Syndrome

Jee Eun Kim et al. J Clin Neurol. .
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Abstract

Background and purpose: Middle East respiratory syndrome (MERS) has a high mortality rate and pandemic potential. However, the neurological manifestations of MERS have rarely been reported since it first emerged in 2012.

Methods: We evaluated four patients with laboratory-confirmed MERS coronavirus (CoV) infections who showed neurological complications during MERS treatment. These 4 patients were from a cohort of 23 patients who were treated at a single designated hospital during the 2015 outbreak in the Republic of Korea. The clinical presentations, laboratory findings, and prognoses are described.

Results: Four of the 23 admitted MERS patients reported neurological symptoms during or after MERS-CoV treatment. The potential diagnoses in these four cases included Bickerstaff's encephalitis overlapping with Guillain-Barré syndrome, intensive-care-unit-acquired weakness, or other toxic or infectious neuropathies. Neurological complications did not appear concomitantly with respiratory symptoms, instead being delayed by 2-3 weeks.

Conclusions: Neuromuscular complications are not rare during MERS treatment, and they may have previously been underdiagnosed. Understanding the neurological manifestations is important in an infectious disease such as MERS, because these symptoms are rarely evaluated thoroughly during treatment, and they may interfere with the prognosis or require treatment modification.

Keywords: Guillain-Barré syndrome; Middle East respiratory syndrome; neurological complications; peripheral neuropathy.

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1. Timeline of clinical events and virological results in patient 1. The onset of neurological symptoms and their course during the sedative state were uncertain, and are indicated by the dotted lines. HD: hospital day, IVIG: intravenous immunoglobulin, MV: mechanical ventilator, TA: tracheal aspirate.
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