Conclusions

The autoimmune mechanisms in narcolepsy on the one hand and profound activation of the immune system during COVID-19 may increase the occurrence of narcolepsy in susceptible individuals after COVID-19. In our patient, the diagnosis of narcolepsy was made relatively late, approximately nine months after symptom onset. Thus, we recommend considering the diagnosis of narcolepsy in patients with excessive fatigue and drowsiness following COVID-19. This consideration should be based on careful history taking, specifically inquiring about symptoms of narcolepsy, followed by specific sleep studies according to the constellation of symptoms. We also recommend measuring inflammatory markers and hypocretin, as well as HLA typing in patients with narcolepsy after COVID19 to guide a better understanding of the pathogenesis of narcolepsy following COVID-19.