SARS-CoV-2-associated Guillain–Barré syndrome in four patients: what do we know about pathophysiology?

Abstract

Background A growing number of Guillain-Barré syndrome (GBS) and Miller Fisher Syndrome (MFS) cases following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are reported. Nevertheless, this association is still debated, and pathophysiology remains unclear. Methods Between April and December 2020, in three hospitals located in Brussels, Belgium, we examined four patients with GBS following SARS-CoV-2 infection. Results Neurological onset occurred 3 weeks after SARS-CoV-2 symptoms in all patients. Three patients presented with acute inflammatory demyelinating polyneuropathy (AIDP) and had negative anti-ganglioside testing: two suffered from a severe SARS-CoV-2 infection and had good clinical outcome after intravenous immunoglobulin (IVIG) treatment; one with mild SARS-CoV-2 infection had spontaneously favorable evolution without treatment. The fourth patient had critical SARS-CoV-2 infection and presented acute motor and sensory axonal neuropathy (AMSAN) with clinical features highly suggestive of brainstem involvement, as well as positive anti-ganglioside antibodies (anti-GD1b IgG) and had partial improvement after IVIG. Conclusions We report four cases of SARS-CoV-2-associated GBS. The interval of 3 weeks between SARS-CoV-2 symptoms and neurological onset, the clinical improvement after IVIG administration, and the presence of positive anti-ganglioside antibodies in one patient further support the hypothesis of an immune-mediated post-infectious process. Systematic extensive antibody testing might help for a better understanding of physiopathology.

Neuro-Ophthalmic Complications of COVID-19 Infection and Vaccination

“…( 70 ) This is supported by the incubation period, the positive response to IVIG, and the presence of anti-ganglioside antibodies in 20% of reported cases. ( 67 , 70 )…”

“…( 67 , 68 , 69 ) A proposed mechanism by which MFS develops is through an immune-mediated post infectious process. ( 70 ) This is supported by the incubation period, the positive response to IVIG, and the presence of anti-ganglioside antibodies in 20% of reported cases. ( 67 , 70 )…”

Investigation of Neurological Complications after COVID-19 Vaccination: Report of the Clinical Scenarios and Review of the Literature

“…SARS-CoV-2 enters host cells via the S protein, which not only binds to the ACE2 receptor but also binds to sialic-acid-containing glycoproteins and gangliosides on cell surfaces [ 34 ]. Post-infectious immune-mediated mechanism was hypothesized because anti-ganglioside antibodies were recognized in several COVID-19 patients [ 35 , 36 ]. It may be hypothesized that SARS-CoV-2 spike-bearing gangliosides may form a neoantigen recognized by unidentified antibodies [ 36 ].…”

“…Post-infectious immune-mediated mechanism was hypothesized because anti-ganglioside antibodies were recognized in several COVID-19 patients [ 35 , 36 ]. It may be hypothesized that SARS-CoV-2 spike-bearing gangliosides may form a neoantigen recognized by unidentified antibodies [ 36 ]. Cytokine storm was another possible mechanism of GBS induced by COVID [ 37 ].…”

COVID‐19 as a trigger of Guillain‐Barré syndrome: A review of the molecular mechanism

“… 106 Anti‐GQ1B antibodies are one of the main autoantibodies of MFS, a subtype of GBS. 103 A variety of autoantibodies against human antigens, including neurofascins, 107 sulfatides, 108 and gangliosides, 109 were found among the post‐COVID‐19 GBS patients. Previous studies showed that antiganglioside antibodies are present in a few proportions of GBS patients after COVID‐19.…”