Un caso de neuralgia amiotrófica tras vacunación frente a COVID-19

Abstract

Introduction: neuralgic amyotrophy is an inflammatory disorder of the brachial plexus with a poorly understood pathophysiology, possibly related to immunological phenomena. It is characterized by acute and intense pain, accompanied by muscle weakness and altered results in electromyographic and nerve conduction studies. Having no specific treatment, it is approached through physiotherapy and symptomatic control. Case history: we present the case of a 37-year-old woman, with no relevant history, who developed the condition after being vaccinated against SARS-CoV-2. The patient responded discreetly to physical therapy, conventional analgesia and corticosteroids. After 10 months of treatment, the decision was made to use pulsed radiofrequency and ultrasound-guided plexus block of the plexus, which achieved better results. A year after the onset of pain, the patient’s symptoms had improved, although she had not been able to return to her professional activity as a policewoman. Discussion: very few cases of neuralgic amyotrophy have been reported after SARS-CoV-2 vaccination. The differential diagnosis includes many common muskuloskeletal and neurologic disorders, which can mislead professionals and delay identification of the disease, especially in the context of massive vaccination campaigns. Conventional analgesia is often insufficient to address these patients’ complaints; thus, scheduled invasive techniques need to be considered. Given the rarity of the condition and its impact on the personal and professional life of the patient, we highlight the importance of an early diagnosis and smooth communication with the patient. Finally, we stress the value of declaring adverse reactions as a sign of professionalism and an asset in establishing a constructive doctorpatient relationship. Conclusion: neuralgic amyotrophy is a disorder of the brachial plexus, possibly related to immunological phenomena such as SARS-CoV-2 vaccination. In patients with insufficient response to physical therapy and pharmacological treatment, interventions such as pulse radiofrequency or ultrasound-guided plexus blocks can be valuable. A swift diagnosis and a transparent doctor-patient relationship are highlighted as key assets in managing these cases.