Atypical onset of obsessive-compulsive disorder at age 50 following post-SARS-COV-2 syndrome: A case report

The coronavirus disease 2019 (SARS-COV-2) pandemic has been associated with an increased risk of developing or exacerbating obsessive-compulsive disorder (OCD). This report presents a case of OCD onset in a 50-year-old male following recovery from acute SARS-COV-2 infection, highlighting the potential neuroinflammatory and neuroimmune mechanisms involved.

Mr. A, a 50-year-old cook with no prior psychiatric history, developed a loss of smell and taste by SARS-COV-2. This sensory impairment triggered severe anxiety, leading to compulsive checking behaviors and reassurance-seeking after recovering from SARS-COV-2. Initial treatment with fluvoxamine at 50 mg/day was insufficient, and his symptoms necessitated inpatient care. His compulsive behaviors continued during hospitalization, and escalation of fluvoxamine to 150 mg/day, alongside adjunctive risperidone at 3 mg/day was needed. Along with cognitive-behavioral therapy (CBT) advises, this resulted in symptom stabilization and eventual discharge. Postdischarge, Mr. A's OCD symptoms remained stable with ongoing medication, despite continued sensory disturbances.

This case illustrates the atypical onset of OCD in an older adult following SARS-COV-2 infection, potentially driven by neuroinflammation and altered neural pathways. The partial response to fluvoxamine and the need for risperidone suggest that SARS-COV-2-related OCD may involve complex neuroimmune changes beyond serotonin dysregulation. This case emphasizes the importance of recognizing neuropsychiatric complications in SARS-COV-2 survivors and underscores the need for further research into the mechanisms and management of SARS-COV-2-related neuropsychiatric symptoms, including OCD.