Guillain-Barré syndrome associated with SARS-CoV-2 infection: A case report with long term follow up

Abstract

A 50-years old male presented with quadriplegia and paresthesia and was diagnosed as Guillain-Barré syndrome (GBS). He was found positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) six weeks prior to the onset of weakness. GBS disability score was 4. Electrophysiology showed acute inflammatory demyelinating polyradiculopathy. Anti-SARS-CoV-2 IgG was found positive. Immunological tests for Campylobacter jejuni , Zika virus, Hepatitis E virus,Herpes Simplex virus, Haemophilus influanzae and Mycoplasma pneumoniae were negative. Patient received standard dose of intravenous immunoglobulin and after six months had almost complete recovery of muscle power. This case represents possible association of SARS-CoV-2 infection and GBS with good clinical outcome.

Diagnosing SARS-CoV-2 associated Guillain-Barre syndrome requires cerebro-spinal-fluid studies

“…We do not agree that “till date, more than 70 cases with SARS-CoV-2 associated GBS” have been reported ( Papri et al, 2021 ). In a recent review about SARS-CoV-2 associated GBS, at least 220 patients as per the end of December 2020 have been collected ( Finsterer and Scorza, 2021 ).…”

“…We read with interest the article by Papri et al about a 50yo male who was diagnosed with Guillain Barre syndrome (GBS) subtype acute inflammatory demyelinating polyneuropathy (AIDP) according to the National Institute of Neurological Disorders and Stroke (NINDS) criteria upon the clinical presentation and nerve conduction studies (NCSs) 6 weeks after onset of an infection with SARS-CoV-2 ( Papri et al, 2021 ). The patient received immunoglobulines and recovered slowly but almost completely over a period of 6 months ( Papri et al, 2021 ). The study is appealing but raises the following comments and concerns.…”

Commentary: The spectrum of neurological manifestations related to COVID-19 and vaccinations

“…There was a pressing need in the beginning to understand the systemic manifestations but along the way it became clear that SARS-CoV-2 was also a neurovirulent virus. This has been evident through the several publications of paraand post-infectious neurological sequelae (Jeanneret et al, 2021;Moreno-Escobar et al, 2021;Papri et al, 2021;Sheikh et al, 2021). SARS-CoV-2 affects both the central and peripheral nervous system with the latter being more likely affected during acute viral illness (Sheikh et al, 2021).…”

“…Several mechanisms for viral involvement have been proposed, including development of a cytokine storm leading to fever, production of antibodies targeting myelin, fibrinogen, transthyretin, or albumin resulting in extensive damage. Interestingly, the ganglioside antibodies associated in AIDP were not significantly identified (Papri et al, 2021;Sheikh et al, 2021). E-mail address: Rohini.d.samudralwar@uth.tmc.edu.…”

“…In contrast, post-infectious GBS was reported by Papri et. Al using the Brighton criteria in the setting of negative PCR and positive IgG antibodies ( Papri et al, 2021 ). Para- and post-infectious clinical manifestations have ranged from sensorimotor forms, with lower extremity weakness being more common, to Miller Fisher Syndrome (MFS) and multiple cranial nerve involvement.…”