Amar Jadhav, MD
Intensivist
SSM Health St. Mary's Hospital-St. Louis, United States
Disclosure information not submitted.
Alexandre Lacasse, MD, MSc
Infectious Disease Specialist, Internal Medicine Residency Program Director
SSM Health St. Mary's Hospital-St. Louis, United States
Disclosure information not submitted.
Victoria Johnson, PA-C
Physician assistant neurology
SSM Health St. Mary's Hospital-St. Louis, United States
Disclosure information not submitted.
Polo Banuelos, MD
Neurologist
SSM Health St. Mary's Hospital-St. Louis, United States
Disclosure information not submitted.
Vikas Kumar, MD, PhD
Neurologist, Neurophysiologist
SSM Health St. Mary's Hospital-St. Louis, United States
Disclosure information not submitted.
Title: Post Covid-19 infection in pregnancy: a case report of Acute Motor Axonal Neuropathy (AMAN).
Case Report Body:
Introduction: COVID-19 disease has increasingly reported neurological complications. Guillain Barre syndrome (GBS) and its variants are one example. Acute Motor Axonal Neuropathy (AMAN) is a GBS variant characterized by axonal damage. Pregnancy entails attenuated immunological reaction, therefore, the immune mediated GBS, and its variants are rarely reported in pregnancy. Our case is a pregnant patient who developed AMAN post COVID-19 infection.
Description: 26-years old 34 weeks gestation primigravida presented to outside hospital with acute onset of facial paresthesia and lower extremity weakness. Within 3 days symptoms progressed to dysphagia, diplopia, and hoarseness. Of note, 2 weeks prior she tested positive for SARS-CoV-2 PCR after febrile illness. Initially she was suspected to have Miller Fisher Syndrome and was transferred to our facility for higher critical and fetal-maternal care. Routine blood work, brain and spine imaging were unrevealing. CSF analysis showed albumin-cytologic dissociation with 51 mg/dl protein. She required intubation for airway protection and negative inspiratory force, and was started on intravenous immunoglobulin therapy (IVIG). Shortly, spontaneous premature vaginal delivery of viable male infant ensued. Motor weakness and paresthesia progressed, along with dysautonomia. Further work up showed negative Acetylcholine receptor antibodies, equivocal C. Jejuni antibody, negative anti-GQ1 antibody, but positive anti-GD1a antibody. Electromyography (EMG) nerve conduction study showed pattern of multifocal axonal motor neuropathy without demyelinating features. She finished 5-day course of IVIG. She was successfully extubated on day 10. She improved gradually with physical and occupational therapy and was able to ambulate with walker and was discharged on day 16 to skilled rehabilitation facility.
Discussion: GBS is rarely reported in pregnant patients, due to naturally attenuated immune response. Our pregnant patient had AMAN post COVID-19, which led to premature delivery, and prolonged recovery. Serological workup (positive anti-GD1a antibody) and EMG study suggested the diagnosis of AMAN. Multidisciplinary approach, early use of IVIG and physical-occupational therapy proved key for recovery. Post COVID-19 neurological syndromes necessitate close monitoring and multiple investigation.