Amyotrophic Lateral Sclerosis and its Masks, a Comorbid Pathology with a Rapid Fatal Outcome: Case Report

INTRODUCTION. Despite the fact that more than 150 years have passed since the first mention of amyotrophic lateral sclerosis (ALS), the issues of etiology, pathogenesis, diagnosis and treatment of this disease are still not fully resolved. However, the results of recent research in the field of genetics with the identification of genes associated with ALS, understanding the mechanisms of disease development and, as a result, the creation of effective drugs give hope that in the near future the disease will cease to be fatal. AIM. To analyze domestic and foreign publications on the etiology, pathogenesis, diagnosis and treatment of amyotrophic lateral sclerosis. To present a clinical case of a patient with amyotrophic lateral sclerosis. MATERIAL AND METHODS. The analysis of domestic and foreign publications for the period 1997-2024 is carried out. The sources of the Russian scientific electronic library eLibrary, RSCI databases, PubMed were used. CASE PRESENTATION. A patient is presented who, at the age of 56, developed mixed paresis of the right hand, followed by the development of mixed tetraparesis and simultaneously bulbar syndrome within 3 months. Differential diagnosis was performed between spondylogenic cervical myelopathy, endocrinopathy and ALS. Based on anamnestic data, clinical picture, rate of progression of symptoms, results of electroneuromyography, lack of improvement against the background of therapy, the main diagnosis was made: amyotrophic lateral sclerosis, a primary generalized form with mixed tetraparesis, bulbar syndrome. 2 weeks after discharge from the hospital in a stable condition, the patient was diagnosed with COVID-19 coronavirus infection, with a rapid fatal outcome from respiratory failure (7 months after the debut of ALS). CONCLUSION. A feature of the described ALS case is a rather rare primary generalized form of the disease (having such unfavorable prognosis factors as the development of bulbar syndrome at the beginning of the disease, a short time period from the appearance of the first symptoms to diagnosis), the presence of masking pathology in the form of spondylogenic myelopathy and the addition of COVID-19 with a rapid fatal outcome. With all the severity of ALS and an unfavorable prognosis, the presence of comorbid pathology can make the course of the disease even more dramatic. KEYWORDS: amyotrophic lateral sclerosis, comorbid pathology, coronavirus infection (COVID-19)