COVID-19 infection as trigger of chronic inflammatory demyelinating polyneuropathy (CIDP)

Case presentation: In March 2020, during the first outbreak of COVID-19 pandemic, a seven years-old boy, presented flu-like symptoms with anosmia. The parents presented the same symptoms but did not search medical service. Around 8 weeks later, he presented an acute progressive symmetric ascending flaccid tetraparesis, evolving 28 days after to the worst weakness in lower limbs, being at this moment unable to walk without support. The cerebrospinal fluid (CSF) showed albuminocytologic dissociation; electroneurography demonstrated demyelinating sensory and motor polyneuropathy. Serological test for SARS-CoV-2 IgG result was positive. Patient was diagnosed with Guillain Barrè Syndrome (GBS). On follow up he showed neurological improvement.

Discussion: In January 2022, he presented the same clinical picture of the initial event, preceded by flu- like symptoms 4 weeks before. At the hospital admission RT-PCR of nasal swab for SARS-CoV-2 was positive. CSF showed albuminocytologic dissociation, and electroneurography demonstrate peripheral motor sensory demyelinating polyneuropathy with secondary motor axonal degeneration, evidencing another demyelinating event. Intravenous immunoglobulin pulse was initiated with improvement and discharge after 8 days. Nerve ultrasound in right upper limb and cervical region, identified enlarged proximal median and ulnar nerves, and bilateral C6-C7 root nerve enlargement, hence, differential diagnostic as CIDP was made.

Final comments: CIDP is a rare autoimmune disorder in the spectrum of GBS, a chronic/progressive disorder. During the outbreak of COVID-19, several autoimmune neurological diseases have been reported associated. We present a challenging pediatric case of COVID-19 as trigger of CIDP.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023