Covid-19 associated Guilliane Barre Syndrome

Shubham Goswami*,Vipin Dev*,Ritika Sud** Rosmy Jose***

*Resident,**Professor, ***Assistant Professor, Department Of Medicine, Lady Hardinge Medical College

 https://meditropics.com/cr2-2022-2/

ABSTRACT

SARS-CoV 2019, was initially thought to be primarily affecting the respiratory system. However, over past 2 years it has evolved into a virus with not just respiratory tropism but, with a potential to affect all the systems of the human body. Among the many systems, neurological involvement has been increasingly identified over past 2 years. The manifestations can range from a simple headache to life threatening conditions like Guillain Barre Syndrome (GBS) and encephalopathy. We are reporting one such case of COVID associated GBS.

KEY WORDS

SARS-CoV 2019, GBS.

Guillain Barre Syndrome is an acute, areflexic, ascending paralysis of autoimmune nature. It is commonly preceded by an infection or immunization. Many viruses including nCoV-2019 and bacteria have been implicated in etiology of GBS.

CASE REPORT

A 55 year, old female known hypertensive, presented to the emergency with complaints of weakness of both lower limbs for 1 day. Patient had tested COVID positive 10 days back. Patient was minimally symptomatic at that time and was sent for home isolation.

 At admission examination revealed PR- 90/min, BP-140/90 mmHg, SpO2- 97% on room air. Neurological examination revealed bilateral lower limb hypotonia, hyporeflexia (1+) and bilateral mute plantars. Rest systemic examination was normal.

Initial lab parameters were normal. CSF analysis revealed albumin-cytological dissociation. Based on the clinical presentation and CSF findings a diagnosis of Guillain Barre syndrome was made. Patient was shifted to ICU and was started on IVIG.

By day 2 of hospital stay the weakness progressed to involve both upper limbs and patient was intubated due to respiratory distress. Repeat complete blood count and complete metabolic panel were normal, ABG showed hypoxia, chest X ray and CT spine was clear.

On day 3, patient had an episode of atrial fibrillation which was terminated by electrical cardioversion. Anticoagulation and amiodarone infusion was started. On the same evening patient succumbed to cardiac arrest.

DISCUSSION

Neurological system involvement in COVID can acutely be due to direct cytopathic effect of virus, cytokine associated manifestation or an immune mediated neurological damage. GBS which is an immune mediated syndrome can be life threatening due to respiratory or autonomic involvement.

In this patient the onset of weakness to total paralysis was within 48 hrs. The terminal event which was an episode of atrial fibrillation followed by a cardiac arrest could be attributed severe autonomic involvement.

REFERENCES

1. Stephen L.H Hauser, Anthony A Amato. Guillian Barre syndrome and other immune mediated neuropathies. In: J Larry Jameson, Denis L. Kasper, Dan L. Longo, Anthony S. Fauci, Stephen L. Hauser, Joseph Loscalzo(Eds). Harrisonʾs principle of internal medicine. 20^thMc Graw Hill Education.2018;p3225-3230.
2. Kamel W.A, Ibrahim Ismail I, Al-Hashel J.Y. Guillian Barre syndrome following covid-19 infection: First case report from Kuwait and review of the literature. Dubai Med J 2021;4:107-11.