Neurological Consequences of COVID-19: A Curious Case of Delayed Onset Guillain-Barre

Abstract

SARS-CoV-2 is responsible for causing the COVID-19 pandemic and over 4 million deaths globally. Clinical symptoms range from asymptomatic infection, viral syndrome, and pneumonia, to acute respiratory distress syndrome. Guillain-Barre syndrome (GBS), an acute demyelinating inflammatory polyneuropathy, may be a manifestation of infection and must be recognized quickly by clinicians to avoid neurological deterioration in these patients. Here, we present an interesting case of GBS in a patient with a previous COVID-19 infection. A 63-year-old male with a past medical history of hypertension, chronic obstructive pulmonary disease, obesity, and recent COVID-19 infection just five weeks prior to the presentation without COVID-19 vaccination presented to a family medicine clinic due to a history of falls as well as lower extremity numbness, weakness, and paresthesias for the past 36 hours. The patient’s MRI and lumbar puncture were unremarkable and the patient was transferred to a tertiary care center. The patient was diagnosed with GBS secondary to his COVID-19 infection five weeks prior. He received a standard five-dose regimen of 400 mg/kg/day of intravenous immunoglobulin and demonstrated rapid improvement in response to therapy. Temporal factors associated with disease such as the seemingly delayed onset of symptoms after COVID-19 viral infection in comparison to other cases of GBS, as well as the rapid progression of symptomatology, are of note. Healthcare providers should still consider GBS as a possibility in patients with a relatively distant history of COVID-19 infections. Rapid progression of symptoms should also be monitored as this may result in earlier respiratory morbidity and mortality in the absence of appropriate diagnosis and treatment.