First Reported US Case of Guillain-Barré Linked to COVID-19

Megan Brooks

June 24, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The first official US case of Guillain-Barré syndrome (GBS) associated with COVID-19 has been reported by neurologists from Allegheny General Hospital in Pittsburgh, Pennsylvania, further supporting a link between the virus and neurologic complications, including GBS.

As previously reported by Medscape Medical News, physicians in China reported the first case of COVID-19 that initially presented as acute GBS. The patient was a 61-year-old woman returning home from Wuhan during the pandemic.

Subsequently, physicians in Italy reported five cases of GBS in association with COVID-19.

The first US case is described in the June issue of the Journal of Clinical Neuromuscular Disease.

Unique Features

Like cases from China and Italy, the US patient's symptoms of GBS reportedly occurred within days of being infected with SARS-CoV-2.

"This onset is similar to a case report of acute Zika virus infection with concurrent GBS suggesting a parainfectious complication," first author Sandeep Rana, MD, and colleagues note.

The 54-year-old man was transferred to Allegheny General Hospital after developing ascending limb weakness and numbness that followed symptoms of a respiratory infection. Two weeks earlier, he initially developed rhinorrhea, odynophagia, fevers, chills, and night sweats.

The man reported that his wife had tested positive for COVID-19 and that his symptoms started soon after her illness. The man also tested positive for COVID-19.

His deficits were characterized by quadriparesis and areflexia, burning dysesthesias, mild ophthalmoparesis, and dysautonomia. He did not have the loss of smell and taste documented in other COVID-19 patients.

He briefly required mechanical ventilation and was successfully weaned after receiving a course of intravenous immunoglobulin.

Compared with other cases reported in the literature, the "unique clinical features" in the US case are urinary retention secondary to dysautonomia and ocular symptoms of diplopia. These highlight the variability in the clinical presentation of GBS associated with COVID-19, the researchers note.

They add that with the Pittsburgh patient, electrophysiologic findings were typical of demyelinating polyneuropathy seen in patients with GBS. The case series from Italy suggests that axonal variants could be as common in COVID-19–associated GBS.

"Although the number of documented cases internationally is notably small to date, it's not completely surprising that a COVID-19 diagnosis may lead to a patient developing GBS. The increase of inflammation and inflammatory cells caused by the infection may trigger an irregular immune response that leads to the hallmark symptoms of this neurological disorder," Rana said in a news release.

"Since GBS can significantly affect the respiratory system and other vital organs being pushed into overdrive during a COVID-19 immune response, it will be critically important to further investigate and understand this potential connection," he added.

J Clin Neuromuscul Dis. 2020;21:240-242. Abstract

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