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.