A 44-Year-Old Hispanic Man with Loss of Taste and Bilateral Facial Weakness Diagnosed with Guillain-Barré Syndrome and Bell’s Palsy Associated with SARS-CoV-2 Infection Treated with Intravenous Immunoglobulin

Abstract

Patient: Male, 44-year-old Final Diagnosis: COVID-19 • Guillain-Barré syndrome Symptoms: Facial paralysis Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • Medicine, General and Internal • Neurology Objective: Rare disease Background: This case report is of a patient who presented with loss of taste and facial weakness and was diagnosed with Guillain-Barré syndrome (GBS) and Bell’s palsy, associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. GBS is a neurological emergency defined as acute inflammatory demyelinating polyneuropathy. The patient responded to intravenous immunoglobulin (IVIG) treatment. Case Report: We present the case of a 44-year-old Hispanic man who came for evaluation of bilateral facial weakness and lack of taste sensation. He had lower motor neuron facial weakness. His head computed tomography and brain magnetic resonance imaging scans did not show any pathological abnormalities. He tested positive for SARSCoV-2 by a nasopharyngeal swab reverse transcription polymerase chain reaction (RT-PCR) test. Cerebrospinal fluid (CSF) analysis via lumbar puncture revealed elevated protein levels, no leukocytes, and a negative Gram stain. The CSF RT-PCR test for SARS-CoV-2 was negative. PCR tests of the CSF for other viral infections were negative. A diagnosis of GBS was made, and he was treated successfully with IVIG. After the fourth dose of IVIG, the patient was able to close his eyes, frown, show his teeth, and smile. Conclusions: Our case is rare because the patient did not present with lower extremity weakness, but only with bilateral Bell’s palsy. Physicians should be aware of GBS because it is a neurological emergency for which COVID-19 can be a risk factor. Early diagnosis and treatment of GBS can prevent neurological disability.

Cerebrospinal fluid in COVID-19: A systematic review of the literature

“…As is evident by the fact that 303/430 (70%) patients we identified had CSF SARS-CoV-2 PCR testing performed, it is feasible to perform PCR testing for SARS-CoV-2 in CSF [ [5] , [6] , [7] , [8] , [9] , [10] , 15 , 17 , 22 , 24 , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [68] , [69] , [70] , [71] , 73 , 74 , [76] , [77] , [78] , 81 , 84 , 88 , 89 , 95 , 97 , 98 , 101 , 103 , 105 , 108 , 109 , 111 , 113 , 116 , 119 , 122 , 123 , 125 ,…”

SARS-CoV-2 mediated neuroinflammation and the impact of COVID-19 in neurological disorders

“…All patients experienced Bell’s Palsy during infection. Treatment ranged from antivirals and/or steroids or intravenous immunoglobulins [ [153] , [154] , [155] , [156] ].…”

Cerebrospinal fluid from COVID-19 patients with olfactory/gustatory dysfunction: A review

“…Of 242 publications from December 1, 2019 and November 18, 2020 that described a unique patient diagnosed with COVID-19 via SARS-CoV-2 PCR or serology who had a neurological symptom and had CSF obtained, we identified 51 that met inclusion criteria. After review of the 51 publications, we identified 70 patients reported to have altered olfactory and/or gustatory function (anosmia/cacosmia/hyposmia and/or ageusia/dysgeusia/hypogeusia); 40 (57%) had both olfactory and gustatory dysfunction, 17 (24%) had isolated olfactory dysfunction and 13 (19%) had isolated gustatory dysfunction [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] . In addition to altered olfactory and/or gustatory function, 39 (56%) had symptoms that localized to the central nervous system and 31 (44%) had symptoms that localized to the peripheral nervous system.…”

“…In 13/66 (20%) patients, the CSF WBC count was 0 cells/µL or the CSF WBC:RBC ratio was <1:1,000. The majority of patients (38/66; 58%) had a CSF WBC count of 1-5 cells/µL or were noted to have “no pleocytosis” or “normal WBC.” [10] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [29] , [30] , [33] , [36] , [37] , [38] , [40] , [41] , [42] , [44] , [45] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] There were 11/66 (17%) patients who had a CSF WBC count >5 cells/µL or noted to be “increased.” [8] , [12] , [17] , [28] , [31] , [32] , [33] , [34] , [35] , [39] , [46]

Fig. 3 Cerebrospinal Fluid White Blood Cell Count Results.

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