COVID-19 as a Trigger of Recurrent Guillain–Barré Syndrome

Abstract

Coronavirus 2019 (COVID-19) has been reported to trigger Guillain–Barré syndrome (GBS). While uncommon, recurrent GBS (rGBS) episodes, triggered by antecedent viral infections, have been reported in a small proportion of GBS patients, here we describe a patient with a recurrent case of GBS, occurring secondary to COVID-19 infection. Before this patient’s episode, he had two prior GBS flares, each precipitated by a viral infection followed by complete recovery besides intermittent paresthesias. We also consider the nosology of this illness in the spectrum of rGBS and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), with their differing natural histories, prognosis, and therapeutic approaches. For patients who have a history of inflammatory demyelinating polyradiculopathies who develop COVID-19, we recommend close observation for neurologic symptoms over the next days and weeks.

Acute-onset chronic inflammatory demyelinating polyneuropathy after COVID-19 infection and subsequent ChAdOx1 nCoV-19 vaccination

“…A case of recurrent GBS, occurring secondary to COVID-19 infection, has also been described, wherein the patient had two prior flares of GBS, each episode being precipitated by a viral illness followed by complete recovery and a recent event following COVID-19 infection. 2 …”

“…1 A case of recurrent GBS, occurring secondary to COVID-19 infection, has also been described, wherein the patient had two prior flares of GBS, each episode being precipitated by a viral illness followed by complete recovery and a recent event following COVID-19 infection. 2 CIDP is a relapsing-remitting or progressive inflammatory demyelinating polyneuropathy, which has a varied clinical presentation. CIDP can be a challenging diagnosis for physicians due to the heterogeneity of presentations, ranging from distal versus proximal onset, symmetric versus asymmetric onset and sensory versus motor variants.…”

“…Mild neurological symptoms include headache, syncope, myalgia, anosmia and ageusia. Certain severe neurological illnesses associated with COVID-19 include encephalopathies, stroke, encephalitis, acute disseminated encephalomyelitis as well as other immune neuropathies like GBS, 1 recurrent GBS 2 and exacerbation of pre-existing CIDP. 3 4 Additionally, human coronavirus 229E and OC43 have been linked to disorders like multiple sclerosis (MS), and murine coronavirus JHMV (JHM strain mouse hepatitis virus) which is likewise known to induce an MS-like disease in murine models.…”

COVID-19 infection presented as Guillain-Barre Syndrome: Report of two new cases and review of 116 reported cases and case series

“…After thorough literature review, we found a substantial number of reported cases and case series of Covid-19 infection presented with GBS. Table 1 summarizes demographic, type of relationship with Covid-19, clinical and GBS sub-types, response to specific GBS treatment, and outcome of different GBS cases who presented in concurrent with Covid 19 infection [[ [3] , [4] , [5] , [6] , [7] , [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] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] ...…”

“…Common neurological symptoms of COVID-19 are headache, dizziness, dysgeusia/ageusia, hyposmia/anosmia, seizure, stroke, and encephalopathy [ 2 ]. There have been reported cases of Guillain-Barré Syndrome (GBS) associated with COVID-19 from different parts of the world [[ [3] , [4] , [5] , [6] , [7] , [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] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] ,…”