A possible Guillain-Barré syndrome/transverse myelitis overlap syndrome after recent COVID-19

Abstract

Neurological manifestations are common in SARS-CoV-2 infection, including life-threatening acute muscle weakness, due to neuromuscular disorders such as acute transverse myelitis (TM) and Guillain-Barré syndrome (GBS). These syndromes can rarely coexist and present as an overlap syndrome. Here, we report a patient who developed acute symmetrical proximal lower limb weakness 5 days after diagnosis of COVID-19. GBS was diagnosed due to the presence of motor signs, albumin-cytological dissociation in cerebrospinal fluid examination and axonal damage according to nerve condition tests. However, abnormal areas on MRI of the thoracic spine and lack of improvement with intravenous immunoglobulin supported a diagnosis of TM. Therefore, a possible overlap between GBS and TM was established. To our knowledge, this is the third case report of GBS/TM overlap syndrome after COVID-19. The patient’s full and rapid recovery with intravenous corticosteroids and plasmapheresis supports our diagnosis.

Onset of Guillain-Barre Syndrome and Transverse Myelitis Following COVID-19 Vaccination

“…However, the existence of the two syndromes occurring together, known as GBS/TM overlap syndrome, is presumed to be rare. Most cases of this syndrome are related to recent infections, such as from the Zika virus or Mycoplasma bacteria [ 7 ]. Little is known regarding the most effective treatments to address the coexistence of GBS and TM, although current literature suggests that the use of IVIG is effective at addressing the overlap syndrome [ 15 ].…”

“…GBS and TM may both present with similar symptoms and may both coexist in patients following COVID-19 infection and vaccination, known as GBS/TM overlap syndrome [4,6,7]. Vaccinations against SARS-CoV-2 are mostly based on the messenger ribonucleic acid (mRNA) and viral vector platforms, where common symptoms following vaccinations include fevers, chills, nausea, headaches, and more [8,9].…”

Functional Recovery and Regenerative Effects of Direct Transcutaneous Electrical Nerve Stimulation in Treatment of Post-COVID-19 Guillain–Barré and Acute Transverse Myelitis Overlap Syndrome: A Clinical Case

“…The complete pathophysiology of ATM is unknown, but many authors believe that the disease develops as a result of an autoimmune reaction, which may be idiopathic or associated with post-infectious or para-infectious events [ 3 ]. Recently, several clinical cases of ATM associated with post-COVID-19 infection have been reported [ 4 , 5 , 6 ] and, in extremely rare cases, in combination with another autoimmune disease—Guillain–Barré syndrome (GBS) [ 7 , 8 ]. In 40% of patients with ATM and in 30% of patients with GBS, residual motor, sensory and autonomic disorders may persist for months or even years due to resistance to pharmacotherapy [ 9 , 10 ].…”