%0 Journal Article
%T Case-Control Study of Individuals With Small Fiber Neuropathy After COVID-19.
%A McAlpine L
%A Zubair AS
%A Joseph P
%A Spudich S
%J Neurol Neuroimmunol Neuroinflamm
%V 11
%N 3
%D 2024 May
%M 38630952
%F 11.36
%R 10.1212/NXI.0000000000200244
%X <B>OBJECTIVE: </B>To report a case-control study of new-onset small fiber neuropathy (SFN) after COVID-19 with invasive cardiopulmonary exercise testing (iCPET). SFN is a critical objective finding in long COVID and amenable to treatment.<BR><B>METHODS: </B>A retrospective chart review was conducted on patients seen in the NeuroCOVID Clinic at Yale who developed new-onset SFN after a documented COVID-19 illness. We collected demographics, symptoms, skin biopsy, iCPET testing, treatments, and clinical response to treatment or no intervention.<BR><B>RESULTS: </B>Sixteen patients were diagnosed with SFN on skin biopsy (median age 47, 75% female, 75% White). 92% of patients reported postexertional malaise characteristic of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and 7 patients underwent iCPET, which demonstrated neurovascular dysregulation and dysautonomia consistent with ME/CFS. Nine patients underwent treatment with IVIG, and 7 were not treated with IVIG. The IVIG group experienced significant clinical response in their neuropathic symptoms (9/9) compared with those who did not receive IVIG (3/7; p = 0.02).<BR><B>CONCLUSIONS: </B>Here, we present preliminary evidence that after COVID-19, SFN is responsive to treatment with IVIG and linked with neurovascular dysregulation and dysautonomia on iCPET. A larger clinical trial is indicated to further demonstrate the clinical utility of IVIG in treating postinfectious SFN.<BR><B>METHODS: </B>This study provides Class III evidence. It is a retrospective cohort study.