Patrick McKillion, MD, FCCP
Dr.
Lakeland Medical Center Saint Joseph, United States
Disclosure information not submitted.
Title: COVID-19 Associated Acute Inflammatory Demyelinating Polyneuropathy (Guillain-Barré Syndrome)
Case Report Body: INTRODUCTION: Severe infection of the SARS-CoV2 virus is characterized by acute respiratory failure with multiple organ system dysfunction. The involvement of the nervous system in severe COVID-19 cases is a developing topic drawing increasing interest among intensivists. We describe a case of Acute Inflammatory Demyelinating Polyneuropathy (AIDP) also known as Guillain-Barré Syndrome (GBS) associated with a COVID-19 infection.
Description: A 59-year-old male presented with a one week history of cough, fevers, chills and generalized malaise and was found to be positive for COVID-19. He reported ascending weakness and paresthesias starting with his bilateral lower extremities progressing to urinary hesitancy and dyspnea. Neurologic examination also revealed diffuse areflexia, right sided Bell’s palsy, and dysarthria. Imaging of the head and spine was negative for any acute ischemia or hemorrhage. A lumbar puncture demonstrated normal opening pressures and cytology showed no viral, fungal or bacterial infection. Elevated protein content of the cerebral spinal fluid was consistent with a diagnosis of AIDP and he was continued on intravenous immunoglobulin. Negative-Inspiratory Force (NIF) was diminished at (-)30 cm/H2O and given his advancing neurologic and respiratory decline, the patient ultimately required prolonged intubation for agitation with hallucinations and multiple therapeutic bronchoscopies for recurrent mucus plugging. His hospital course was complicated by development of pulmonary embolism, atrial fibrillation with rapid ventricular response and a delay in anticoagulation from a bleeding esophageal ulcer. He required extensive rehabilitation with chronic neurologic deficits.
Discussion: AIDP secondary to COVID-19 infection is an uncommon presentation of this novel disease. AIDP has been documented to increase the risk of stroke, dementia, and damage to muscle, vascular and nervous systems. Combined with the developing information and risks that we know about the SARS-CoV2 virus, physicians require a broad differential and familiarity with atypical presentations to ensure timely identification and treatment.