Worsening of parkinsonism from COVID-19 infection

Summary of observations:
The patient is a 65 year old male with Parkinson’s disease diagnosed about 3-4 years ago, who presented to our Movement disorders clinic recently with complaints of worsening parkinsonism. He noticed in the past few weeks that his gait had deteriorated with stumbling and falls. He also had some shortness of breath when climbing a half flight of stairs. He did not have fever nor shortness of breath at baseline. He was on carbidopa/levodopa 25/100 2 tablets three times a day. He had gone to the emergency room 2 days prior to the clinic visit where was afebrile with normal vital signs and had blood tests including CBC and electrolytes which were normal and a MRI brain that showed some cerebral atrophy. On exam, pt had mild increased tone throughout with mild slowed rapid alternating movements, left more than right side. No rest tremor. He had slowed gait and mild stooped posture, with mild postural instability. Over the course of the next 2 weeks, the patient was monitored via frequent phone calls. His condition deteriorated to the point where he was unable to walk and he presented to the ER. He was admitted to the hospital where he tested positive for COVID-19. I think this case highlights the possibility that COVID-19 infection can present with worsening parkinsonism symptoms in patients with Parkinson’s disease, without obvious respiratory symptoms nor fever.