Maria Carla Canizares Otero, MD
Resident Physician
Aventura Hospital and Medical Center
Aventure, Florida
Disclosure information not submitted.
Anamika Neralla, MD
Chief Resident Physician
Aventura Hospital and Medical Center, United States
Disclosure information not submitted.
Livasky Concepcion, MD
Attending Physician, Associate Program Director
Aventura Hospital and Medical Center, United States
Disclosure information not submitted.
Title: Post COVID related Guillain Barre Syndrome involving bilateral facial nerves and lower extremities
Case Report Body:
INTRODUCTION SARS-CoV-2 has established itself as a deadly virus for its acute disease and its post viral complications including Gullain Barre (GBS). GBS is a rare autoimmune neurological condition with an incidence of 1-2 cases per 100,000 per year. Most cases are linked to prior pathogenic infections with few cases linked to COVID-19. Our case is an atypical presentation of post-covid GBS with bilateral facial palsy and ascending motor weakness.
DESCRIPTION A 34 year-old male with no past medical history presented with multiple neurological complaints. Two weeks prior to presentation, he reported flu-like symptoms and testing positive for COVID. Five days prior to presentation, he noticed a right sided facial droop along with neuropathy that began in the right foot and quickly progressed to both legs and hands. His symptoms became bilateral, he was unable to smile, close his eyes or fully move his mouth. He also reported saddle anesthesia and urinary/fecal retention.
On admission, he was afebrile with stable vital signs and unremarkable bloodwork. A computed tomography angiogram of the chest revealed hypoventilatory changes. The neurological examination disclosed bilateral lower extremity weakness, bilateral facial droop, inability to taste at the tip of his tongue, smile or fully close his eyes. He was unable to walk several steps. A lumbar puncture was performed and cerebrospinal fluid (CSF) analysis revealed elevated total protein with albuminocytological disproportion but otherwise normal.
DISCUSSION Microbiologic CSF testing was negative for VDRL, cryptococcus antigen, syphilis, HIV, Lyme and influenza. GQ1b antibodies were negative. The patient had an MRI that was negative for other pathologies such as cord compression or multiple sclerosis. He received a 5 day course of IVIG and was treated symptomatically with a close airway watch. Respiratory status was monitored by frequent negative inspiratory force testing and vital capacity studies along with pulse oximetry. He had gradual motor improvement in his facial and bilateral lower extremity muscles.
As COVID- 19 cases continue to rise with more virulent strains, it is important to keep in mind post COVID conditions which can include Guillain Barre presenting in atypical manner such as bilateral facial palsy.