Post SARS-CoV-2 Guillain-Barré syndrome in a child: case report and review of the literature

Abstract

Guillain-Barré syndrome has been defined as a post-infectious immune-mediated polyneuropathy. COVID-19 usually presents with respiratory symptoms but can less commonly present with extra-respiratory manifestations such as neurological symptoms. Few cases were published in the literature regarding post-COVID-19 infection Guillain-Barré in the pediatric age group. In this paper, we present a 13-year-old male with possible Guillain-Barré syndrome occurring 2 weeks after a presumed COVID-19 infection. We conducted a systematic review and searched for published pediatric cases until March 2022. We included 35 patients in 25 publications.

Take children with progressive quadruparesis after SARS-CoV-2 infection seriously

“…We disagree with the presentation that cerebral and spinal magnetic resonance imaging (MRI) was probably normal due to steroid use a few days before imaging [ 1 ]. Since steroids are often ineffective in GBS [ 2 ], enhancing nerve roots should have been visible despite application of steroids.…”

“…We read with interest the article by Al Jaberi et al about a 13-year-old male who developed progressive quadruparesis 2 weeks after a mild SARS-CoV-2 infection that did not require hospitalisation [ 1 ]. Only 4 weeks after onset of the neurological manifestations was there a neurological evaluation of suspected SARS-CoV-2 associated Guillain–Barre syndrome (GBS), which led to the diagnosis of acute, inflammatory demyelinating polyneuropathy (AIDP) [ 1 ]. The patient benefited from intravenous immunoglobulins (IVIG) [ 1 ].…”

“…Only 4 weeks after onset of the neurological manifestations was there a neurological evaluation of suspected SARS-CoV-2 associated Guillain–Barre syndrome (GBS), which led to the diagnosis of acute, inflammatory demyelinating polyneuropathy (AIDP) [ 1 ]. The patient benefited from intravenous immunoglobulins (IVIG) [ 1 ]. The study is appealing but raises concerns that need to be discussed.…”

“…We should be told why the diagnosis was delayed by 4 weeks. The patient presented to the emergency department two weeks after onset of COVID-19 with progressive, ascending weakness [ 1 ]. Such a clinical picture in a child or adult should ring the alarm bells and lead to immediate clarification of the abnormalities.…”

“…We should be informed about the rationale for applying steroids together with intravenous immunoglobulins (IVIG) [ 1 ]. Steroids are usually ineffective for GBS [ 4 ].…”