key: cord-0876823-sujsnw2w
authors: Monaco, Maria Rita Lo; Colacicco, Giovanni; Marotta, Jessica; Bentivoglio, Anna Rita
title: An educational case series of Parkinson’s disease during the COVID-19 pandemic
date: 2020-09-12
journal: Rev Neurol (Paris)
DOI: 10.1016/j.neurol.2020.07.007
sha: de2ac2454e2b3e4c9375a68eeaa6f3e68d64e7c0
doc_id: 876823
cord_uid: sujsnw2w

nan

Parkinson's disease (PD) and parkinsonism are very common neurological diseases that generally affects older individuals [1] . Some studies suggest that patients with PD exhibit increased susceptibility to bacterial and viral infections and an excess of pneumonia is reported as a causeof death in patients with Parkinson's disease [2] . Therefore, PD could influence the course and the result of COVID-19; however, this association remains unknown.

We describe five parkinsonian patients who tested positive for COVID-19 from 8 March to 18

April 2020, at the Fondazione Policlinico Universitario"Agostino Gemelli", IRCCS (Table 1) . She also started a course of hydroxychloroquine and lopinavir/ritonavir per institutional protocol and correction of hydro-electrolytic imbalance. Her hospitalization was uncomplicated;

gastrointestinal disorders improved, and she was discharged to a rehabilitation facility after a 16-day hospitalization.

72-year-old man with drug-induced parkinsonism. He was taking olanzapine 15 mg, escitalopram 20 mg, and trihexyphenidyl 4 mg. He was referred to the Emergency Department with altered mental status and lethargy noted a few hours prior and six days of dry cough and malaise. He was normotensive, febrile (38°C), with room-air SpO2 at 80%, which corrected to 96% on nasal cannula (4 L/min). His chest radiograph revealed multifocal bilateral infiltrates.

The serum glucose was 182 mg/dL. He received hydroxychloroquine and tocilizumab (a monoclonal antibody against the IL-6 receptor) per institutional protocol. Olanzapine was reduced and, trihexyphenidyl was suspended. His confusion gradually resolved, oxygen requirements improved, and was discharged to home after an 11-day hospitalization.

66-year-old man with a 10-year history of PD presented to the Emergency Department with three days of dry cough and dyspnea. He was hypertensive (181/78 mmHg), febrile (38° C), with room-air SpO2 at 96%. The chest radiograph showed bibasilar infiltrates. He was hospitalized and started a course of hydroxychloroquine and lopinavir/ritonavir per institutional protocol. He was also started on broad-spectrum antibiotics for presumed superimposed pneumonia. Because there are drug interactions between levodopa and antiretrovirals, the dosage of levodopa was halved. After two days, he developed acute generalized dystonia; antiretrovirals were suspended and melevodopa through a nasogastric tube was administered at the prior dosage. He gradually improved and was discharged to a rehabilitation facility after a 21-day hospitalization.

95-year-old woman, nursing home resident with PD complicated by severe cognitive impairment presented to the Emergency Department with lethargy noticed one day before the presentation. She was hypotensive (80/60 mmHg), afebrile, with room-air SpO2 at 92%. On examination, she was using accessory respiratory muscles. The chest radiograph showed left mid-lower lobe infiltrates. She was admitted, started on broad-spectrum antibiotics, and additionally treated with support oxygen therapy. Later she developed a Klebsiella pneumonia urinary infection in the hospital ward. Finally, her family opted for comfort care, and she expired on hospital day 9.

56-year-old man with juvenile parkinsonism, presented to the Emergency Department with three days of dry cough, subjective fever, and myalgias. He was normotensive, afebrile, with room-air oxygen saturation (SpO2) at 98%. He did not require hospital admission, was followed-up one month later and his symptoms had resolved.

COVID-19 is a heterogeneous disease that varies from asymptomatic in some patients to fatal in others. Advanced age, male gender, and comorbidity have been identified as risk factors for adverse prognosis [3, 4] .

We wanted to report studying the effects that parkinsonian syndrome could have on patients with COVID-19.

Our patients were older adults aged 56 to 95 years. All had underlying conditions, identified as high-risk comorbidities. Still, none of the patients needed mechanical ventilation or intensive care management, and with the exception of one fatality, they all eventually recovered ( Table 1 ). The only fatality was a patient with multiple risk factors, including advanced age, nursing home residence, multiple comorbidities.

This small case series raises the possibility that COVID-19 infection may not necessarily be associated with poor outcome in patients with parkinsonism. This must be confirmed in a larger study.

The authors declare no conflict of interest 1 

Incidence of parkinsonism and Parkinson disease in a general population: the Rotterdam Study

Mortality and causes of death in idiopathic Parkinson's disease: results from the Aberdeen whole population study

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the