COVID-19 Associated Guillain–Barré Syndrome: A Report of Nine New Cases and a Review of the Literature

Abstract

Background: Guillain–Barré syndrome (GBS)—a rare condition characterized by acute-onset immune-mediated polyneuropathy—has been registered as a neurological manifestation of COVID-19, suggesting a possible link between these two conditions. Methods: We report a case series of patients with COVID-19-related GBS hospitalized in the Neurology Department of Colentina Clinical Hospital, Bucharest, Romania, between March 2020 and March 2021. Several variables were analyzed, such as the mean interval between the onset of COVID-19 symptoms and neurological ones, clinical features, treatment course, and outcome. Further on, we conducted a thorough literature review based on the PubMed and ScienceDirect scientific databases. Results: A total of 9 COVID-19 patients developed symptoms of GBS, out of which in 7, it manifested as an acute inflammatory demyelinating polyneuropathy (AIDP). Five patients presented respiratory failure, 2 requiring mechanical ventilation. All patients received a course of intravenous immunoglobulins, 2 additionally requiring plasma exchange. Upon discharge, all but 1 patient (who had not regained the ability to walk) had a positive outcome, and 1 died during admission. In the literature review, we analyzed the published sources at the time of writing. Conclusions: A link between COVID-19 and GBS might be possible; therefore, increased vigilance is required in the early identification of these cases for prompt diagnosis and treatment. Some notable differences such as an earlier onset of GBS symptoms, higher respiratory dysfunction, and higher mortality rates in COVID-19 patients have been observed between the presentation of GBS in the context of COVID-19 and GBS of other causes.

Guillain-Barre Syndrome linked to SARS-CoV-2 infection – meta-analysis and literature review

“…There are some papers reporting GBS in SARS-CoV-2 individuals who had no upper respiratory tract infection symptoms. 20,21,23,28 Furthermore, Zhao et al and Cea et al also reported cases where the latency period was 0 days as GBS symptoms preceded COVID-19 symptoms. 25,32 The postponement of GBS neurological features is related to the pathogenesis of GBS in SARS-CoV-2 infection.…”

Locked-in Presentation of Guillain-Barre Syndrome Following SARS-COVID-19 Infection

“…Additionally, patients without an otherwise identifiable cause for GBS should be screened for COVID, as the autoimmune reaction can occur even in the absence of infectious symptoms. 12 The prevalence of COVID-associated GBS has declined since the introduction of COVID vaccines, however, cases are still being reported. 13 Furthermore, investigations are underway to determine the risk of GBS resulting from the COVID vaccine itself.…”

Non-Multisystem Inflammatory Syndrome in Children—Postacute Sequelae of Paediatric COVID-19: Autoimmune or Autoinflammatory? A Systematic Review of the Reported Cases

“…The occurrence of GBS within two weeks rather than 2-4 weeks after the infectious agent mimics the picture seen with the Zika virus. This suggests a proinflammatory state leading to direct nerve damage rather than the presence of autoantibodies [34].…”