A Case of Guillain-Barré Syndrome Associated With COVID-19

Abstract

A novel member of human RNA coronavirus, which is an enveloped betacoronavirus, has been termed severe acute respiratory syndrome coronavirus-2 (SARS COV-2). The illness caused by SARS COV-2 is referred to as the coronavirus disease 2019 (COVID-19). It is a highly contagious disease that has resulted in a global pandemic. The clinical spectrum of COVID-19 ranges from asymptomatic illness to acute respiratory distress syndrome, septic shock, multi-organ dysfunction, and death. The most common symptoms include fever, fatigue, dry cough, dyspnea, and diarrhea. Neurological manifestations have also been reported. However, the data on the association of Guillain-Barré syndrome (GBS) with COVID-19 are scarce. We report a rare case of a COVID-19-positive 36-year-old immunocompromised male who presented with clinical features of GBS. His clinical examination showed generalized weakness and hyporeflexia. The cerebrospinal fluid (CSF) analysis showed albuminocytological dissociation. Intravenous immunoglobulin (IVIG) was administered based on the high clinical suspicion of GBS. The patient’s neurological condition worsened with progression to bulbar weakness and ultimately neuromuscular respiratory failure requiring mechanical ventilation. His nerve conduction studies were consistent with demyelinating polyneuropathy. He received five plasma exchange treatments and was successfully weaned from mechanical ventilation. A brain and cervical spine magnetic resonance imaging was obtained to rule out other causes, which was normal. COVID-19 is believed to cause a dysregulated immune system, which likely plays an important role in the neuropathogenesis of GBS.

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

“…1 patient had elevated IgG index (14.67; reported normal <0.86) and IgG synthesis (293.5 mg/day; reported normal 9.2 mg/day) with normal albumin consistent with intrathecal synthesis [ 117 ]…”

“…CSF oligoclonal bands were tested in 114 patients who did not have a positive CSF SARS-CoV-2 PCR or positive CSF antibodies to SARS-CoV-2 (103 (90%) who had symptoms that localized to the CNS and 11 (10%) who had symptoms that localized to the PNS) [ 9 , 10 , 19 , 20 , 35 , 36 , 42 , 44 , 45 , 58 , 69 , 74 , 79 , 81 , 101 , 112 , 113 , 116 , 117 , 126 , 127 , 130 , 135 , 136 , 147 , 149 , 152 , 154 , 160 , [168] , [169] , [170] , [171] , 177 , 181 , 182 , [185] , [186] , [187] , [188] , 191 , 194 , 203 , 205 , 207 , 209 , 212 , 213 , 215 , 216 , 218 , 233 , 242 , 245 ]. Of these, 35 (31%) had matched CSF and serum bands [ 9 , 35 , 79 , 112 , 113 , 127 , 147 , 170 , 171 , …”

“…Of the patients who did not have a positive CSF SARS-CoV-2 PCR, CSF SARS-CoV-2 antibodies or CSF-specific oligoclonal bands, 45 had CSF immunoglobulins measured [ 9 , 10 , 42 , 45 , 49 , 57 , 58 , 62 , 69 , 74 , 81 , 113 , 117 , 148 , 181 , 182 , 187 , 194 , 205 , 215 , 220 , 242 , 246 ]. Of these, 29 (64%) patients had normal immunoassays [ 42 , 45 , 49 , 57 , 58 , 62 , 69 , 74 , 81 , 113 , 181 , 182 , 187 , 194 , 215 , 242 , 246 ].…”

“…There were 2/45 (4%) patients who did not have a positive CSF SARS-CoV-2 PCR, CSF SARS-CoV-2 antibodies or CSF-specific oligoclonal bands who had immunoglobulin results consistent with intrathecal antibody synthesis [ 117 , 205 ]. Rajdev et al presented a patient with Guillain-Barré Syndrome who had an elevated IgG index (14.67; reported normal <0.86) and markedly elevated IgG synthesis (293.5 mg/day; reported normal 9.2 mg/day), with normal albumin levels and absence of oligoclonal bands [ 117 ]. The authors commented that these findings suggest intrathecal IgG synthesis, as there was no clear evidence of blood-brain barrier breakdown, but concluded that his polyneuropathy was postinfectious.…”

“…Oligoclonal bands were initially matched, then were absent. Both patients improved and were discharged from the hospital [ 117 , 205 ].…”