COVID‐19–associated Guillain‐Barré syndrome: The early pandemic experience

Abstract

Guillain-Barré syndrome (GBS) is an inflammatory polyradiculoneuropathy associated with numerous viral infections. Recently, there have been many case reports describing the association between coronavirus disease-2019 (COVID-19) and GBS, but much remains unknown about the strength of the association and the features of GBS in this setting. We reviewed 37 published cases of GBS associated with COVID-19 to summarize this information for clinicians and to determine whether a specific clinical or electrodiagnostic (EDx) pattern is emerging. The mean age (59 years), gender (65% male), and COVID-19 features appeared to reflect those of hospitalized COVID-19 patients early in the pandemic. The mean time from COVID-19 symptoms to GBS symptoms was 11 days. The clinical presentation and severity of these GBS cases was similar to those with non-COVID-19 GBS. The EDx pattern was considered demyelinating in approximately half of the cases. Cerebrospinal fluid, when assessed, demonstrated albuminocytologic dissociation in 76% of patients and was negative for severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) in all cases. Serum antiganglioside antibodies were absent in 15 of 17 patients tested. Most patients were treated with a single course of intravenous immunoglobulin, and improvement was noted within 8 weeks in most cases. GBS-associated COVID-19 appears to be an uncommon condition with similar clinical and EDx patterns to GBS before the pandemic. Future studies should compare patients with COVID-19-associated GBS to those with contemporaneous non-COVID-19 GBS and determine whether the incidence of GBS is elevated in those with COVID-19.

Guillain-Barré syndrome after COVID-19 in Japan

“…Acute motor and sensory axonal neuropathy and acute motor axonal neuropathy types were observed in 13.5% and 2.7% of cases. 4 In the present report, we discuss a case of axonal-type GBS associated with SARS-CoV-2 infection, where the patient was tested for various antiganglioside antibodies. Furthermore, we review the cases of SARS-CoV-2-infection-related GBS reported to date, in order to provide insight into the clinical characteristics and pathological mechanisms underlying the disease.…”

COVID-19 associated with sensorimotor polyradiculoneuropathy and skin lesions: A case report

“…( Lampe et al, 2020 ; Sedaghat and Karimi, 2020 ; Camdessanche et al, 2020 ) There might be a concern about thromboembolic complications of administration IVIg since there is a hypothesis of thrombotic susceptibility of COVID-19. ( Caress et al, 2020 ) But no adverse effects have been reported until the publication of this article.…”

“…The second SARS-CoV-2 PCR of nasopharyngeal swap was positive, so in this case, neuropathy possibly occurred during symptomatic infection with the SARS-CoV-2. In other reported cases of GBS associated with COVID-19, the nadir of neurologic symptoms was within 7 days of onset, sometimes 2–3 days and infrequently in the second week of neurologic illness ( Caress et al, 2020 ). Our patient was treated with IVIg, like almost all other reported GBS associated with SARS-CoV-2.…”

“…The most common reported dermatologic presentations in confirmed or highly suspected patients are morbilliform, pernio-like, urticaria, macular erythema, vesicular, papulosquamous and retiform purpura. ( Freeman et al, 2020 ) We had limitation of antiganglioside antibody testing to identify a specific target of autoimmune process and also SARS-Cov-2 PCR on CSF, but it has been reported negative in all the other published cases ( Caress et al, 2020 ).…”

Extrapulmonary Clinical Manifestations in COVID-19 Patients

“…77 However, it is also possible that GBS cases have been incorrectly attributed to critical illness neuromyopathy. 78 Miller Fisher syndrome. Miller Fisher syndrome is an acute peripheral neuropathy that develops after exposure to viral, bacterial, and fungal pathogens.…”