key: cord-1012605-fxuba3hk
authors: Oguz‐Akarsu, Emel; Ozpar, Rifat; Mirzayev, Haci; Acet‐Ozturk, Nilufer Aylin; Hakyemez, Bahattin; Ediger, Dane; Karli, Necdet
title: Guillain–Barré Syndrome in a Patient with Minimal Symptoms of COVID‐19 Infection
date: 2020-06-04
journal: Muscle Nerve
DOI: 10.1002/mus.26992
sha: 8e4c857e006784d505417266e1bc93955176f1d1
doc_id: 1012605
cord_uid: fxuba3hk

nan

The new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has become a pandemic. Here, we report a patient with Guillain-Barré syndrome (GBS) who had evidence of a coronavirus disease 2019 (COVID-19) infection, but was otherwise asymptomatic for COVID-19 except for a low-grade fever.

A 53-year-old previously healthy woman presented with a 3-day history of dysarthria associated with progressive weakness and numbness of the lower extremities. She had no history of recent infection or vaccination. Vital signs were normal. A neurologic examination revealed mild dysarthria due to jaw weakness and bilateral, predominantly lower limb weakness, with 4-/5 strength in knee and ankle flexor and extensor muscles, and 4-/5 in the left and 4+/5 in right hip This article is protected by copyright. All rights reserved.

flexor muscles by the Medical Research Council (MRC) scale. She could walk only with assistance.

There was slight weakness in her hand muscles. Reduced sensation to pinprick was found distally to the upper thighs. Tendon reflexes were absent in the lower extremities. GBS was considered to be the most likely diagnosis. Biochemical screening (electrolytes, liver and kidney function tests, C-reactive protein) and HIV test were normal other than mild neutropenia (1.49 cells/µL) and a high monocyte percentage (19.77; normal 4-12) in the complete blood count. Nerve conduction studies (NCS) confirmed a demyelinating pattern with conduction blocks and temporal dispersion in motor nerves ( Figure 1A , Table 1 ). Ulnar and median nerves demonstrated normal minimal F-wave latencies with decreased persistence (median 55%, ulnar 65%) and increased chronodispersion (median 22.1ms, ulnar 18.0ms) (Table 1, Figure 1B and a CSF test for SARS-CoV-2 was negative. Two weeks after the onset of symptoms, the neurologic findings had improved markedly; MRC scores were 4+/5 in lower limb muscle groups and she was able to walk without assistance.

Neurologic manifestations during the course of COVID-19 infection have been described. 1 Previous reports of GBS and COVID-19 demonstrated marked respiratory symptoms prior to or concurrent with the onset of neurologic symptoms. [2] [3] [4] In contrast, our patient with GBS had evidence of a COVID-19 infection, but was otherwise asymptomatic for COVID-19 except for a low-grade fever.

We speculate that the pathophysiologic mechanism of GBS in COVID-19 may be para-infectious rather post-infectious, likely due to 'molecular mimicry' that preferentially affects the nervous system before the respiratory system. Another explanation could be direct viral neuropathogenic effects on the nervous system. 5 This possibility that this patient acquired the virus nosocomially cannot be ruled out because we did not perform microbiologic testing at the time of admission. In the neurology clinic, during the hospitalization period, none of the other patients or staff had symptoms, and none of the contacts This article is protected by copyright. All rights reserved. 

Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study

Online ahead of print 3

Guillain-Barré Syndrome associated with SARS-CoV-2 infection. IDCases 2020

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A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)

Clinical and electrophysiological parameters distinguishing acute-onset chronic inflammatory demyelinating polyneuropathy from acute inflammatory demyelinating polyneuropathy