text: Small fiber neuropathy associated with SARS CoV 2 infection The development and persistence of neurological symptoms following severe acute respiratory syndrome coronavirus 2 SARS CoV 2 infection is referred to as long haul syndrome We aimed to determine whether small fiber neuropathy SFN was associated with SARS CoV 2 infection We retrospectively studied the clinical features and outcomes of patients who were referred to us between May 2020 and May 2021 for painful paresthesia and numbness that developed during or after SARS CoV 2 infection and who had nerve conduction studies showing no evidence of a large fiber polyneuropathy We identified 13 patients Eight women and five men with age ranging from 38 67 y Follow up duration ranged from 8 to 12 mo All patients developed new onset paresthesias within 2 mo following SARS CoV 2 infection with an acute onset in seven and co existing autonomic symptoms in seven Three patients had pre existing but controlled neuropathy risk factors Skin biopsy confirmed SFN in six all of whom showed both neuropathy symptoms and signs and two also showed autonomic dysfunction by autonomic function testing AFT Of the remaining seven patients who had normal skin biopsies six showed no clinical neuropathy signs and one exhibited signs and had abnormal AFT Two patients with markedly reduced intraepidermal nerve fiber densities and one with normal skin biopsy had severe and moderate coronavirus disease 2019 COVID 19 the remainder experienced mild COVID 19 symptoms Nine patients received symptomatic neuropathy treatment with paresthesias controlled in seven 77 8 Our findings suggest that symptoms of SFN may develop during or shortly after COVID 19 SFN may underlie the paresthesias associated with long haul post COVID 19 symptoms 