We report the clinical and immunological features in a case of SARS-CoV-2-induced Guillain-Barré syndrome (Si-GBS), suggesting that (1) Si-GBS can develop even after paucisymptomatic COVID-19 infection; (2) a distinctive cytokine repertoire is associated with this autoimmune complication, with increased CSF concentration of IL-8, and moderately increased serum levels of IL-6, IL-8, and TNF-α; (3) a particular genetic predisposition can be relevant, since the patient carried several HLA alleles known to be associated with GBS, including distinctive class I (HLA-A33) and class II alleles (DRB1*03:01 and DQB1*05:01). To the best of our knowledge, this is the first case of GBS in which SARS-CoV-2 antibodies were detected in the CSF, further strengthening the role of the virus as a trigger. In conclusion, our study suggests that SARS-CoV-2 antibodies need to be searched in the serum and CSF in patients with GBS living in endemic areas, even in the absence of a clinically severe COVID-19 infection, and that IL-8 pathway can be relevant in Si-GBS pathogenesis. Further studies are needed to conclude on the relevance of the genetic findings, but it is likely that HLA plays a role in this setting as in other autoimmune neurological syndromes, including those triggered by infections.

Background. The aim was to assess long-term dynamics and factors associated with the serological response against the Severe Acute Respiratory Syndrome Coronavirus 2 after primary infection. Methods. A prospective longitudinal study with monthly serological follow-up during the first 4 months, and then at 6, 8 and 10 months after the disease onset of all recovered adult in- and out-patients with Coronavirus Disease 2019 (COVID-19) attending Udine Hospital (Italy) during the first wave (from March to May 2020). Results. 542 individuals were included (289 female, mean age 53.1 years), mostly with mild COVID-19 (370, 68.3%). Patients were followed for a median of 302 days (Interquartile Range, 186-311). Overall seroconversion rate within two months was 32% for IgM and 90% for IgG. Seroreversion was observed in 90% of patients for IgM at 4 months and in 47% for IgG at 10 months. older age, number of symptoms at acute onset, severity of acute COVID-19, were all independent predictors of long-term immunity both for IgM (β, linear regression coefficient, 1.10, p=0.001; β 5.15 p=0.014; β 43.84 p=0.021, respectively) and for IgG (β 1.43 p<0.001; β 10.46 p<0.001; β 46.79 p<0.001, respectively), whereas the initial IgG peak was associated only with IgG duration (β 1.12, p <0.001). Conclusions. IgM antibodies disappeared at four months and IgG antibodies declined in about half of patients 10 months after acute COVID-19. These effects varied depending on the intensity of the initial antibody response, age and burden of acute COVID-19.

Introduction: Thyroid function tests (TFT) are extensively used in daily clinical practice. Here we described a case of incongruent TFT both in a pregnant woman and in her newborn. Case presentation: A 32-year-old woman, diagnosed with autoimmune thyroiditis during her first pregnancy, was monitored during her second gestation. At week 5+2 days, TSH and FT4 values, (Dimension VISTA 1500, Siemens Healthineers) were within normal limits. At week 19+5 days, TSH remained normal while FT4, increased approximately by 3-fold. FT4 inconsistency was with both TSH and the clinical status, since she continued to be clinically euthyroid. On the same serum sample, thyroid autoantibodies were negative. At week 25+4 days, the patient complained of palpitations and dyspnea, with tachycardia. Even though TSH was normal, high levels of both FT4 and FT3 were interpreted as evidence of thyroid overactivity and methimazole was started. TFT of the pregnant woman continued to be monitored up throughout gestation. Postpartum FT4 and FT3 gradually returned to normal. TFT, performed on daughter’s serum, three days after birth, showed the same inconsistency of her mother but without clinical signs of congenital hyperthyroidism. Based on the clinical and laboratory setting, the presence of circulating autoantibodies against T3 and T4 (THAb) were suspected and demonstrated by radioimmunoprecipitation. Conclusion: Analytical interferences should be supposed when TFT do not fit with the clinical picture and despite their infrequency, THAb must also be considered. To our knowledge, this is the first case describing the passage of THAb to the newborn.

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