Post-covid Guillain-Barre syndrome with atypical clinical presentation

Case presentation: EVMS, 7 years and 4 months old, started after symptoms of airway infection by the Sars Cov 2 virus with paresthesia and pain in the lower limbs. The condition persisted for more than 20 days with progressive worsening, evolving to tactile, thermal, and painful hypoesthesia from the waist down. During the entire evolution, the patient maintained a preserved gait and associated symptoms of pruritus and anal paresthesia. On physical examination, he presented alteration in exteroceptive sensitivity with anesthesia in the boot, absence of tactile, kinesthetic and artistic sensitivity in the lower limbs, sensory level L5-S1, osteotendinous reflexes (ORT) 1+/4+ overall. Complementary Examinations: Magnetic Resonance of the skull, neuraxis and normal Electroneuromyography. Serology for COVID 19 reagent and Herpes l and II IgG: 28.4 reagent IgM: 0.9 undetermined. Cerebrospinal fluid CSF: Red cells: 0.31 Leukocytes: 2.18 Protein: 22 Cl: 126 Glucose: 52, viral meningitis panel negative. In view of the clinical findings and diagnosis of Guillain-Barré Syndrome (GBS) with a purely sensory presentation, treatment with Human Immunoglobulin was performed with complete resolution of signs and symptoms.

Discussion: Infection with the SARS-CoV-2 virus in the central nervous system causes neuroinflammation and evolves with the cytokine storm. There are frequent reports of neurological syndromes secondary to infection, such as GBS, meningitis, encephalitis, encephalopathy, cerebrovascular accident (CVA), in addition to signs and symptoms such as headache, dizziness, reduced level of consciousness, hyposmia, and hypogeusia. The Guillain-Barré syndrome caused by the new coronavirus theoretically presents itself in a similar way to the pathology caused by other agents. The interval between the onset of symptoms of Covid 19 and the first symptoms of the syndrome varies from 5 to 12 days, with the classic sensorimotor form being the most prevalent manifestation in 75%, as shown in the review by P Zuberbühler et al, 2021. The purely sensitive and late-onset form, such as the one presented in this case, is rarer.

Final comments: It is concluded that the neurological evolution of GBS after COVID showed a good response to treatment with immunoglobulin, and few had respiratory failure.

 

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Artikel online veröffentlicht:
18. September 2023