801 - A Long Road Ahead: Improving Function after A Year of Long COVID and Chronic Fatigue Syndrome Following Multidisciplinary Inpatient Rehabilitation

Case Diagnosis: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), Post Acute Infection Syndrome secondary to COVID-19 (Long COVID)

Case Description: 37 year old female with a history of two COVID-19 infections one year ago presents to inpatient rehabilitation due to generalized weakness suspected by acute care hospital to be due to a psychiatric etiology given her symptoms consisting of significant insomnia, post exertional malaise, slowed cognition, joint aches, worsening orthostatic intolerance, and depressed mood. Symptoms have been worsening over the last year and as a result, she has been unable to work. Prior to symptom onset, she was an avid marathon runner with a PhD and an overall highly motivated individual. Concerns for ME/CFS secondary to a post-acute infectious syndrome from COVID-19 prompted coordination between therapy teams to spread out her therapies during the day, neuropsychiatric consultation, and initiating MTOR therapies (including metformin and rapamycin). Symptoms largely improved throughout her rehabilitation and she was discharged home with improved sleep, endurance, and cognitive functioning.

Discussions: Post Acute Infection Syndrome secondary to COVID-19 (Long-COVID) has been increasingly recognized as an etiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Misdiagnosis of this disease pathology remains prevalent and attribution of symptoms are typically labeled as psychological in origin. Prompt diagnosis by clinicians ensures access to appropriate care to maximize clinical and rehabilitation outcomes. This serves as a unique case of inpatient rehabilitation outcomes of Long-COVID and offers as a guide for outpatient general practitioners and physiatrists to recognize the signs of Long-COVID and optimal and well tolerated treatment options including intensive rehabilitation and benign pharmacologic therapies.

Conclusions: Clinicians should consider ME/CFS in patients with over 6 months of fatigue, post-exertional malaise, and unrefreshing sleep in setting of infections prior to symptom onset, specifically COVID-19. Rehabilitation should consider their fatiguability and malaise. Initiating MTOR therapies to maximize outcomes should also be considered.