key: cord-0830939-62rg6mgn
authors: Kilinc, Duygu; van de Pasch, Suzanne; Doets, Alex Y.; Jacobs, Bart C.; van Vliet, Judith; Garssen, Marcel P.J.
title: Guillain‐Barré syndrome after SARS‐CoV‐2 infection
date: 2020-06-13
journal: Eur J Neurol
DOI: 10.1111/ene.14398
sha: 7a0b7bffedb425ff0a65fd7c99dd8ff5d89efde4
doc_id: 830939
cord_uid: 62rg6mgn

Since the first reports in December 2019 in Wuhan, China, the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) rapidly developed into a pandemic associated with substantial morbidity and mortality. Guillain‐Barré syndrome (GBS) is an acute immune‐mediated polyradiculoneuropathy that may be triggered by various bacterial and viral infections. Reports on possible neurological manifestations of SARS‐CoV‐2 are still scarce. Hereby, we report a case of GBS after an infection with SARS‐CoV‐2.

This article is protected by copyright. All rights reserved Since the first reports in December 2019 in Wuhan, China, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly developed into a pandemic associated with substantial morbidity and mortality.

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy that may be triggered by various bacterial and viral infections. Reports on possible neurological manifestations of SARS-CoV-2 are still scarce.

Hereby, we report a case of GBS after an infection with SARS-CoV-2.

A 50-year-old male with no relevant medical history presented with four days of progressive bilateral facial weakness, paresthesia of distal extremities and an unsteady gait. Four weeks earlier he had experienced an episode of dry cough lasting several days without fever or other symptoms of infection. Due to progression of limb weakness and inability to walk, intravenous immunoglobulin (IVIg) (2g/kg in 5 days) was initiated on day seven of hospitalization and recovery started within days. On day fourteen the patient was discharged with a mild proximal weakness in the lower extremities and facial diplegia.

We describe a case of GBS four weeks after a SARS-CoV-2 infection. To our knowledge this is one of the first cases of a GBS subtype after SARS-CoV-2 infection.

GBS is considered a post-infectious disorder in which the infection may evoke an immune response to peripheral nerve antigens, via 'molecular mimicry' and other mechanisms, resulting in demyelination and/or axonal damage [1] . About two third of GBS cases report an antecedent infection, particularly gastrointestinal tract and respiratory infections [1] .

Previous studies report a peak in the incidence of GBS during epidemics of Zika and influenza viruses [2, 3] . GBS has also been described after infection with other coronaviruses [4] . Zhao et al. recently reported a patient with GBS developing symptoms of SARS-CoV-2 seven days after onset of neurological symptoms [5] . This sequence of events may argue against a post-infectious pathogenesis, although the incubation period of the infection in this case is unknown [5] . Other patients have been described who developed GBS 3-10 days after the first symptoms of SARS-CoV-2 infection, like the current case, which is more in line with the typical sequence of a post-infectious immunemediated disorder [6, 7] .

This article is protected by copyright. All rights reserved Our patient reported an episode of dry cough 3-4 weeks before admission, which is a classical presentation of a mild SARS-CoV-2 infection. Positive IgM and IgG serology for SARS-CoV-2 confirmed the diagnosis. The latency period of 3-4 weeks after infection and negative SARS-CoV-2 PCR in CSF militates against a direct infection of the nervous system and supports a post-infectious immune-mediated pathogenesis [1, 2] .

It is remarkable that all published cases show different clinical features, suggesting a heterogeneous immunological response. Tested antiganglioside antibodies were negative in the current and most previously reported cases, but these antibodies are usually absent in GBS preceded by viral infections [1] .

In the absence of the required studies to establish if SARS-CoV-2 can trigger GBS, clinicians should be aware that the current SARS-CoV-2 pandemic may lead to more cases of GBS. Diagnosis may be hampered by the seemingly heterogeneous presentation. Optimal treatment for these patients is yet to be determined, although our patient showed a rather fast and good response after treatment with IVIg.

Data sharing not applicable -no new data generated

Guillain-Barré syndrome

Guillain-Barré syndrome and influenza virus infection

Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study

Neurological Complications during Treatment of Middle East Respiratory Syndrome

Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? The Lancet Neurology

Guillain-Barré Syndrome Associated with SARS-CoV-2

Miller Fisher Syndrome and polyneuritis cranialis in COVID-19

COV-2: severe acute respiratory syndrome coronavirus 2; GBS: Guillain-Barré syndrome; CSF: cerebrospinal fluid; PCR: Polymerase-chain-reaction, IVIg: intravenous immunoglobulin