key: cord-0777841-fnwgfq3x
authors: Kajita, Mikiya; Sato, Masamichi; Iizuka, Yutaka; Mashimo, Yamato; Furuta, Natsumi; Kakizaki, Satoru
title: Guillain‐Barré syndrome after SARS‐CoV‐2 infection
date: 2021-07-09
journal: J Gen Fam Med
DOI: 10.1002/jgf2.481
sha: a4eaa548d18152f58b01568f8ba4c9c9e60e1689
doc_id: 777841
cord_uid: fnwgfq3x

We herein report a case of Guillain‐Barré syndrome (GBS) after SARS‐CoV‐2 infection. The patient was a close contact with a SARS‐CoV‐2 patient. Initially, she did not have any symptoms and quarantined at a hotel. Dysgeusia and olfactory abnormality appeared at day 6 after testing positive for infection and disappeared by day 9. Subsequently, the patient developed numbness of the arms and legs, difficulty walking, and dyspnea and was referred to our hospital. Her clinical examination showed generalized weakness and hyporeflexia. A cerebrospinal fluid analysis showed albuminocytological dissociation. Her nerve conduction studies were consistent with demyelinating polyneuropathy. Intravenous immunoglobulin was administered based on a diagnosis of GBS.

We herein report a case of Guillain-Barré syndrome (GBS) after SARS-CoV-2 infection. The patient was a close contact with a SARS-CoV-2 patient. Initially, she did not have any symptoms and quarantined at a hotel. Dysgeusia and olfactory abnormality appeared at day 6 after testing positive for infection and disappeared by day 9.

Subsequently, the patient developed numbness of the arms and legs, difficulty walking, and dyspnea and was referred to our hospital. Her clinical examination showed generalized weakness and hyporeflexia. A cerebrospinal fluid analysis showed albuminocytological dissociation. Her nerve conduction studies were consistent with demyelinating polyneuropathy. Intravenous immunoglobulin was administered based on a diagnosis of GBS.

coronavirus disease 2019, COVID-19, demyelinating polyneuropathy, Guillain-Barré syndrome, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2 no remarkable history of complications or medications. Because one of her family was COVID-19 patient, she was considered a close contact without infectious symptoms. Her nasopharyngeal polymerase chain reaction (PCR) of SARS-CoV-2 was positive. Dysgeusia and olfactory abnormality appeared at day 6 but disappeared by day 9.

Around day 10, cough and sputum were noted. Although the cough was improved by medication, numbness of the legs appeared at day 15, followed by numbness of the arms, difficulty walking, and dyspnea. She was referred to our hospital at day 24 after testing positive for infection. Because of the risk of dyspnea progressing to respiratory muscle paralysis, she was treated with intravenous immunoglobulin (IVIG) therapy for 5 days at a dose of 400 mg/kg/day from days 26 to 30.

IVIG was effective, and her symptoms improved. She received physical rehabilitation and was discharged after a hospital stay of 21 days.

Guillain-Barré syndrome is an immune-mediated polyneuropathy. 7 Molecular mimicry exists between nerve and microbial antigens, leading to the development of GBS. 7 Previously discovered coronavirus types, including severe acute respiratory syndrome (SARS) and

Middle East respiratory syndrome (MERS), have been reported to be associated with GBS. 8 Uncini et al. 9 systematically reviewed 42 cases. The median time between the COVID-19 and GBS onset was 11.5 (IQR: 7.7-16) days. 9 The most common clinical features were limb weakness, TA B L E 1 Motor nerve conduction study findings of the median and tibial nerve hyporeflexia, sensory disturbances, and facial palsy. 9 The most frequent phenotype was the classical sensorimotor demyelinating GBS. 9 Albuminocytologic dissociation of CSF was found in 77.8% of patients, and SARS-CoV-2 PCR was negative in all tested patients. 9 Most patients (95.5%) were negative for anti-ganglioside antibodies. 9 In the present case, numbness of the legs appeared nine days after the initial symptoms of COVID-19. Limb weakness, hyporeflexia, sensory disturbances, and facial palsy were observed. Antiganglioside antibodies were also negative in our case. Although she fortunately recovered without mechanical ventilation, her respiratory state was worsened before IVIG treatment.

Because the number of COVID-19 patients in European countries is larger than those in other areas, it is little wonder that GBS patients associated with SARS-CoV-2 have mainly been reported from European countries. Whether or not racial differences are involved with the prevalence of GBS associated with SARS-CoV-2 is unclear. Reports of GBS associated with SARS-CoV-2 are mainly case reports or case series, 5,6 and the systematic reviews published thus far are also meta-analyses of data from case reports. 9,10 Hasan et al. 10 discussed in their meta-analysis that reports from other geographical regions, especially South Asia, are required to confirm the presentation and outcome of SARS-CoV-2-associated GBS. The accumulation and analysis of cases from Asia are needed.

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Satoru Kakizaki https://orcid.org/0000-0003-0224-7093

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