Intravenous immunoglobulin in COVID-19 associated Guillain–Barré syndrome in pregnancy

Abstract

The COVID-19 pandemic has led to a rise in cases of Guillain-Barré syndrome (GBS). This autoimmune sequela is a manifestation of the neurotropism potential of the virus. At present, knowledge regarding the pathophysiology, clinical features, management and outcomes of the condition is still evolving. This paper presents the case of a 22-year-old pregnant patient who came in with a history of upper respiratory tract symptoms followed by acroparaesthesia and progressive ascending weakness. She was confirmed to have COVID-19 and GBS and was subsequently managed with intravenous immunoglobulin (IVIg) followed by supportive therapy. To the authors’ knowledge and based on their literature search, this is the first reported case of GBS in a COVID-19 confirmed pregnant patient who received IVIg.

Pregnancy and neurologic complications of COVID‐19: A scoping review

“…Finally, we reviewed 18 case reports from the selected 17 papers (Tables 1 and 2 ). 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 …”

“…Peripheral nervous system involvement was reported in nine cases 19 , 29 , 30 , 31 , 32 , 33 , 34 , 35 (Table 2 ): GBS 29 , 30 , 31 , 32 , 33 ( n = 5), among which, one case also presented vestibular neuritis 33 ; Bell's palsy 19 , 29 , 34 ( n = 3); and rhabdomyolysis 35 ( n = 1).…”

“…The first symptoms of GBS developed during the first week of COVID‐19 in three cases 30 , 31 , 32 and after the first month in 2 cases. 29 , 33 One patient was diagnosed with GBS with no further investigations, 29 while all the other four cases had been investigated.…”

“…Two cases had undergone brain and spinal cord imaging exams, which proved to be unremarkable. 32 , 33 All four patients underwent complementary investigations: the CSF analysis demonstrated no cells, 30 , 31 normal 33 or increased 32 cell counts, along with elevated 30 , 33 or normal 31 , 32 protein levels; the CSF of two cases was tested for SARS‐CoV‐2 with a negative result 30 , 33 ; nerve conduction studies demonstrated signs of generalized polyradiculoneuropathy 30 , 31 , 32 or mononeuropathies 33 with predominantly demyelinating pattern 31 , 32 , 33 and axonal loss. 30 , 31 , 32 A nerve biopsy was performed, which, in one case, ruled out vasculitis.…”

The Current Evidence Regarding COVID-19 and Pregnancy: Where Are We Now and Where Should We Head to Next?

“…Moreover, the impact of SARS-CoV-2 on the neurological system has been emphasized, as the virus’s neurotropism potential has been in the spotlight of research. Some cases of Guillain–Barre Syndrome associated with COVID-19 have been recently revealed [ 13 , 61 ].…”