A Case of Guillain-Barré Syndrome Caused by COVID-19 Infection

First Author(s)

• 

  Abhinandan Chittal

  MedStar Union Memorial Hospital
  Baltimore, MD

  Disclosure information not submitted.

  Slides and Audio

Co-Author(s)

• SR

  Shiavax Rao, MD,

  Resident Physician
  n/a, United States

  Disclosure information not submitted.
• PL

  Pallavi Lakra, MBBS

  Resident Physician
  MedStar Health, United States

  Disclosure information not submitted.
• RS

  Rabin Shrestha, MD

  Physician
  MedStar Franklin Square Medical Center, United States

  Disclosure information not submitted.

Title: A Case of Guillain-Barre Syndrome Caused by COVID-19 Infection
Case Report Body:

Introduction: Guillain-Barré syndrome (GBS) is a severe acute paralytic neuropathy, with an annual incidence of about 100,000 cases worldwide. Clinically, GBS is primarily characterized by fairly symmetric, ascending progressive muscle weakness accompanied by decreased or absent deep tendon reflexes. While often associated with Campylobacter infection, viral and autoimmune etiologies also exist. We report a rare case of GBS in the setting of COVID-19 infection.

Description: A 73-year-old man with atrial fibrillation and HIV on antiretroviral therapy presented to the emergency room with bilateral upper extremity paresthesia and progressive gait disturbance of two days duration. He denied recent illness or vaccination. On presentation, he was hemodynamically stable and diagnostic workup demonstrated an incidentally positive COVID-19 PCR test. Examination demonstrated diffuse moderate to severe motor weakness and absent reflexes in upper and lower extremities, normal sensation, hoarse phonation, strong cough and mild perioral facial weakness. Lumbar puncture demonstrated albuminocytological dissociation, and subsequent electromyography and nerve conduction studies demonstrated evidence of demyelination with negative anti-ganglioside antibodies; he was diagnosed with GBS secondary to COVID-19 infection. He was admitted to the ICU for close monitoring of respiratory status and received a 5-day course of intravenous immunoglobulin. His hospital course was complicated by progressive muscular weakness, areflexia, new onset urinary retention, increased hoarseness, and dysphagia. He subsequently developed hypoxemic respiratory failure requiring mechanical ventilation and antibiotic therapy, as well as significant dysautonomia with labile pressures and heart rate, managed with beta blockers as needed.

Discussion: GBS associated with COVID-19 infection is uncommon, with few cases reported in the literature. The clinical presentation and severity of these cases has been similar to those without COVID-19, with clinical improvement generally seen within 8 weeks. Prompt recognition and early intervention of GBS in such cases is key, and can potentially improve patient outcomes.