Atypical clinical presentation of COVID-19: a case of Guillain-Barrè Syndrome related to SARS-Cov-2 infection

Abstract

Background: Emerging evidence indicates that SARS-CoV-2 infection may cause neurological complications Case Report: 63-year-old male was admitted for acute progressive symmetric ascending weakness He denied fever, cough, respiratory symptoms and his past medical history wasunremarkable Physical examination showed normal blood pressure, oxygen saturation 98% on air, temperature 36,4°C, heartrate 96 bpm and severe weakness in all limbs Chest X-ray,echocardiogram and abdominal ultrasonography were normal;ECG showed sinus rhythm (96 bpm) Cervical and brain magneticresonance revealed enhancement of the nerve roots Abnormallaboratory tests were: PCR 447 mg/L, ferritin 1857 ng/mL, Ddimer 935 ng/mL, fibrinogen 1013 mg/dL, platelet count69000/μ L and lymphocytopenia (260/μ L) Viral serologies andautoimmune markers were negative Cerebrospinal fluid analysisshowed normal cell count and lack of albumin-cytological dissociation Guillain-Barrè Syndrome (GBS) was suspected and therapy by intravenous immunoglobulin and steroid was started Anasopharyngeal swab was performed, which resulted positive toSARS-CoV-2 on RT-PCR assay The patient was transferred to Infectious Diseases Unit to begin treatment by tocilizumab, hydroxychloroquine and plasmapheresis Conclusions: GBS is immune-mediated disease often triggeredby various infections Since SARS-Cov-2 may lead to a massiverelease of inflammatory cytokines, it could be hypothesized thatan aberrant immune response to SARS-CoV-2 infection inducesinflammatory damage in peripheral nerves with molecular mimicryreaction