COVID-19 and Guillain–Barré Syndrome: A Case Report and Review of Literature

Abstract

During the recent coronavirus disease 2019 (COVID-19) outbreak in Northern Italy, we observed a 57-year-old man developing acute motor-sensory axonal neuropathy, a variant of Guillain-Barré syndrome (GBS), 12 days after severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Similarly to other bacterial and viral infections, dysregulation of the immune system due to post-infectious mechanisms, such as the molecular mimicry, could lead to an indirect damage of the peripheral nervous system related to SARS-CoV-2. GBS causes motor dysfunctions that are not easily recognizable in non-neurological settings or in patients requiring ventilatory assistance. Several reports also suggested that GBS and Miller Fisher syndrome (MFS) could be neurological complications of COVID-19. Therefore, we performed a review of the 29 articles so far published, describing 33 GBS cases and five MFS cases associated with SARS-CoV-2 infection. We recommend awareness of this rare, but treatable, neurological syndrome, which may also determine a sudden and otherwise unexplained respiratory deterioration in COVID-19 patients.

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

“…After review of the 242 documents, we identified 430 patients with COVID-19 diagnosed based on PCR or serologic testing who had acute neurological symptoms prompting CSF testing [ [5] , [6] , [7] , [8] , [9] , [10] , [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] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , …”

“…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 , …”

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

“… [ 402 ] ADEM F 51 Methylprednisolone I.V., IVIg [ 403 ] ANE F 59 High dose dexamethasone [ 404 ] Acute demyelination F 54 Glucocorticoids [ 405 ] Demyelinating lesions F 54 High dose dexamethasone Antiepileptic therapy [ 406 ] AMSAN F 70 IVIg [ 407 ] Guillain-Barré syndrome 7 M 57 IVIg [ 408 ] Guillain-Barré syndrome 1 M, 1 F 26 Plasma exchange, I.V. labetalol, IVIg [ 409 ] ANM and AMAN M 61 Methylprednisolone I.V., plasma exchange [ 410 ] Guillain-Barré syndrome M 57 IVIg [ 411 ] AIDP M 68 IVIg [ 412 ...…”

Is Guillain–Barré Syndrome Associated With COVID-19 Infection? A Systemic Review of the Evidence

“…The countries where the studies were carried out were Italy ( 18 , 27 , 30 – 32 , 39 , 40 , 60 , 65 , 71 , 75 ), China ( 21 ), Iran ( 22 , 62 , 64 , 68 , 69 ), Morocco ( 38 ), Netherlands ( 41 ), Turkey ( 42 ), Canada ( 43 ), Austria ( 47 ), Switzerland ( 48 , 54 ), Spain ( 34 , 35 , 37 , 45 , 46 , 52 , 73 ), United States ( 19 , 33 , 49 , 59 , 66 ), France ( 36 , 44 , 50 ), UK ( 53 , 74 ), Germany ( 55 , 61 , 70 ), Tanzania ( 56 ), Brazil ( 57 ), Saudi Arabia ( 58 ), and Sudan ( 72 ). However, in a few of the studies and the patients, GBS symptoms preceded the symptoms of COVID-19 infection with a range of 7–10 days ( 27 , 28 , 44 ).…”