Guillain-Barre Syndrome: Case Series

Case presentation: Guillain-Barré Syndrome (GBS) is an acute polyradiculopathy that occurs frequently following infectious diseases, which can lead to an immune response to nerve antigens, resulting in demyelination and/or axonal damage. Below, we will report 4 clinical cases of GBS associated with previous SARS-Cov-2 in pediatric patients. One patient was diagnosed with COVID by PCR testing and three with serology testing. Two patients had previous comorbidities – one had Cantu Syndrome and another had Glycogenosis type Ib. The diagnosis of GBS was confirmed by albuminocitologic dissociation in the cerebrospinal fluid in 3 cases, electroneuromyography with demyelination pattern in all 4 cases, and one patient had brain magnetic resonance imaging showing contrast enhancement in the cauda equina e medullary cone, compatible with inflammatory process. The patients with previous comorbidities evolved with respiratory failure and required mechanical ventilation. 3 patients received intravenous immunoglobulin (IVIg), with adequate response. One of them required two IVIg cycles.

Discussion: The association between GBS and coronaviruses has been previously reported following such infections, including MERS-Cov (KIM et al., 2017) and, more recently, SARS-CoV-2. COVID-19 causes an exaggerated immune response with persistent fever, elevated inflammatory markers and pro-inflammatory cytokines. It is likely an immune dysregulation caused by COVID-19 that increases the risk of immune mediated conditions, such as GBS. It can occur as classic post-infectious disease or as part of the already reported Long COVID-19 Syndrome. The majority of reported cases begin acutely a few days after the viral infection.

Final comments: In neurologic presentations compatible with GBS in pediatric patients, we must consider previous or acute SARS-Cov-2 infection as the possible etiology.

 

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Publikationsverlauf

Artikel online veröffentlicht:
18. September 2023