Concurrent thrombotic thrombocytopenic purpura and Guillian Barre Syndrome post infectious diarrhea

Consider SARS-CoV-2 in patients with diarrhoea, vomiting, thrombocytopenia, polyradiculitis, and seizures

“…We read with interest the article by Hussain et al about a 22-year-old female with initially febrile diarrhoea and vomiting who developed generalised purpura, seizures, and muscle weakness on from day 6 of the progressive disease [ 1 ]. In the third week of illness she became disorientated, confused, and mutistic [ 1 ]. She developed renal insufficiency [ 1 ].…”

“…In the third week of illness she became disorientated, confused, and mutistic [ 1 ]. She developed renal insufficiency [ 1 ]. After detailed examination, she was diagnosed with thrombotic thrombocytopenic purpura (TTP) and Guillain-Barre syndrome (GBS), subtype acute, inflammatory demyelinating neuropathy (AIDP) [ 1 ].…”

“…She developed renal insufficiency [ 1 ]. After detailed examination, she was diagnosed with thrombotic thrombocytopenic purpura (TTP) and Guillain-Barre syndrome (GBS), subtype acute, inflammatory demyelinating neuropathy (AIDP) [ 1 ]. She benefited from symptomatic treatment, anti-seizure drugs (ASDs), transient hemodialysis, and plasmapheresis [ 1 ].…”

“…The main limitation of the study is that the patient was not tested for SARS-CoV-2 by PCR [ 1 ]. It is known that SARS-CoV-2 can manifest itself not only in the lungs but also in extra-pulmonary organs, including the intestines, at onset of the disease [ 2 ].…”

“…A second limitation is that no multimodal MRI with contrast medium was used to clarify the cause of seizures, disorientation, and mutism [ 1 ]. Because thrombocytopenia can be associated with venous sinus thrombosis (VST), it is crucial to clarify whether thrombocytopenia has resulted in VST, which is commonly associated with cerebral ischemia, bleeding, and seizures [ 5 ].…”