Juliana Marin, n/a
Intensivist
Hospital Universitario Fundación Santa Fe De Bogotá, United States
Disclosure information not submitted.
Natalia Pedraza-López
Physician
Hospital Universitario Fundación Santa Fe de Bogotá, United States
Disclosure information not submitted.
Title: Acute Motor Axonal Neuropathy Guillain-Barré Syndrome in COVID-19 Patient
Introduction: Guillain-Barré syndrome (GBS) has been described as a rare complication of COVID-19. Little is known about the association SARS-CoV-2 as a causal factor of this syndrome or the strength of the relation between COVID-19 and GBS variants.
Description: A 38 year-old man with mild SARS-CoV-2 infection without other previous medical conditions consulted the emergency room complaining about foreign body sensation after food ingestion. He had not received SARS-CoV-2 vaccine before acquiring the disease. A neck x-ray and esophagogastroduodenoscopy were performed with no relevant findings. The patient developed progresive dyspnea, symmetric weakness in lower extremities. D-dimer suggested an intermediate probability of pulmonary thromboembolism so a computed tomographic pulmonary angiography was performed, with a negative report but showed inflammatory process in lungs. The muscle weakness aggravated within 48 hours and electromyography and nerve conduction studies demonstrated acute motor polyneuropathy with predominant axonal features, without conduction blocks so acute motor axonal neuropathy (AMAN) GBS variant was diagnosed. Later that day, the patient presented dysphagia and cardiovascular dysautonomia with hypertensive crisis. Early intubation and immunoglobulin administration was decided. The patient was admitted to the intensive care unit, where he completed 5 days of therapy without complications. During his hospitalization the patient required sedation multiple times to treat agitation and anxiety. He also required percutaneous tracheostomy for prolonged intubation. Two weeks after the first electromyography, the control showed motor and sensory polyneuropathy, with demyelinating associated compromise. There was deterioration of neural compromise: F waves were absent in four extremities, H-reflex was absent in both posterior tibia and there was no sensory conduction in median and cubital nerves. The patient began to execute simple orders so multidisciplinary rehabilitation activities were started. He is currently stable, receiving quetiapine and valproate and analgesia with hydromorphone.
Discussion: A complication of COVID-19 is GBS. In this case, a young previously healthy patient with mild COVID-19 symptoms presented rapid deterioration, and debuted with a severe GBS AMAN variant.