Can SARS-CoV-2 infection trigger Parkinson Disease? A case report

SARS-CoV-2 infection typically produces respiratory manifestations, although multiple neurological manifestations (seizures, stroke, etc.) have also been reported, it is postulated that SARS-CoV-2 (like most β-coronaviruses), has neurotropic potential. We present a case of Probable Parkinson's Disease (PD) after SARSCoV-2 infection. A 54-year-old male, previously asymptomatic (although, he referred hyposmia for 3 years) presented mild infection (fever, dry cough and anosmia) by SARS-COV-2 (confirmed with positive PCR), with complete recovery after seven days. On the fourteenth day, he developed rest tremor, bradykinesia, and mild rigidity affecting right limbs. Analytical study and brain MRI showed no alterations, DaTSCAN showed asymmetric bilateral putaminal hypocaptation. The final diagnosis was Probable PD, we started treatment with rasagiline 1 mg/24 h, with good clinical response afterwards. Post-infectious parkinsonism has been described in relation with different viral agents. In the same way, it has been proposed that SARS-CoV-2 could affect the CNS and trigger a neurodegenerative process and even PD. To date, only four cases have been described worldwide (including the patient we present). In the case presented, it stands out the asymptomatic state prior to the infection, except for hyposmia (a prodromal symptom of premotor stages of various synucleinopathies). Given the development of parkinsonism two weeks after the onset of respiratory symptoms, we propose that SARS-CoV-2 could have precipitated parkinsonian symptoms in a patient in the premotor phase of PD. In patients that develop tremor after SARS-CoV-2 infection, a thorough neurological examination should be performed, searching for symptoms suggestive of parkinsonism.