Post-infectious Guillain–Barré syndrome related to SARS-CoV-2 infection: a case report

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak emerged in December 2019 in SouthEastern China and rapidly spreaded throughout the globe. Lombardy (and the city of Milan) is one of the hardest-hit regions of Italy. Although fever and respiratory symptoms are the core presenting features of coronavirus disease 2019 (COVID-19), there is an increasing awareness of neurological manifestations as an important factor for the prognosis [1]. We report a patient with a post-infectious Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection. On 13 April 2020, a man in his sixties, living in the urban area of Milan, referred to our emergency department complaining a three-day history of progressive limb weakness and distal paresthesia at four-limbs. His past medical history was unremarkable. Twenty days before he had developed fever (37.7-38.5 °C), headache and myalgia followed by anosmia and ageusia (Fig. 1). He was, therefore, prescribed a home self-isolation protocol until symptom resolution. He recovered within about ten days, except for the persistence of

Guillain–Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases

“…On another issue, despite a few GBS cases seemed to have a para-infectious profile [10,37,38,40,55,56] as described for Zika virus [75], all other reported patients developed neurological symptoms with a typical latency after COVID-19 (median time 14 days). This feature, together with the frequently reported negative nasopharyngeal swab at GBS onset [22,24,36,44,45,52] and clinical improvement after IVIG therapy, seems to support According to Brighton diagnostic criteria [66] GBS, the same finding was less frequently reported [84]. However, caution should be warranted in the interpretation of these results, given that MRI findings might have been underestimated, due to lack of a sufficient number of exams in the context of pandemic-imposed restrictions in the routine clinical setting.…”

“…One of the two asymptomatic subjects never developed fever, respiratory symptoms, or pneumonia [10], whereas the other patient showed an asymptomatic pneumonia at chest computed tomography (CT) [12]. In all but six patients with available data [22,24,36,44,45,52], SARS-CoV-2 RT-PCR with naso-or oropharyngeal swab or fecal exam was positive at first or following tests. Nevertheless, these six patients tested positive at SARS-CoV-2 serology.…”

SARS-CoV-2 and nervous system: From pathogenesis to clinical manifestation

“… Cervical spine MRI: normal EMG/NCS (day 5): prolonged right peroneal/median motor distal latencies, slow left tibial/bilateral peroneal/right ulnar motor conduction velocities, ↓ right median CMAP amplitude, abnormal temporal dispersion of peroneal CMAP, absent F waves, absent median/ulnar SNAPs with sural sparing, overall suggestive of demyelination. IVIG (0.4 g/kg/day for 5 days) Incomplete with slow recovery ( Riva et al, 2020 ) Zaragoza, Spain 56, F Acute hand paresthesia & gait instability; evolving to lumbar pain, progressive proximal paraparesis & areflexia (within 2 days of admission); following by tetraparesis, bifacial & bulbar weakness on IVIG. Fever, cough & dyspnea (15 days prior) Positive COVID-19 nasopharyngeal swab.…”

A rare case of acute motor axonal neuropathy and myelitis related to SARS-CoV-2 infection

“…When reflecting on our case and on the cases in the Italian population [5,7,8], the hypothesis arises that an axonal involvement might be more frequent in GBS related to SARS-CoV-2 infection, in comparison with the typical AMAN prevalence in the European population [2]. However, it is not possible to infer definitive deductions due to the small number of cases registered.…”