Guillain–Barré Syndrome With Bilateral Facial Diplegia Secondary to Severe Acute Respiratory Syndrome Coronavirus-2 Infection

A Case Report

Natalia Ramirez; David Ujueta; Luis Felipe Diaz; Lucila Emilse Folleco; Andrea Rodriguez; Ivan Gaona; Mauricio O. Nava-Mesa

Disclosures

J Med Case Reports. 2021;15(558) 

In This Article

Abstract and Introduction

Abstract

Background: The new coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) owing to its similarity to the previous severe acute respiratory syndrome (SARS), is characterized by causing, in most patients, nonspecific symptoms similar to those of the common flu. It has been reported that many coronavirus disease 2019 (COVID-19) patients presented neurological symptoms that involve the central and peripheral nervous systems. In addition, there have been several reports of patients who presented Guillain–Barré syndrome related to COVID-19, with sensory and motor compromise in the extremities.

Case Presentation: In this report, we describe a rare case of Guillain–Barré syndrome in a 50-year-old Hispanic male with bilateral facial palsy as the only neurological manifestation, following SARS-CoV-2 infection. A complete neurophysiological study showed severe axonal neuropathy of the right and left facial nerves.

Conclusion: Regardless of severity, clinicians must to be aware of any neurological manifestation generated by COVID-19 and start performing more neurophysiological tests to determine if the infection induces an axonal, myelin, or mixed involvement of the peripheral nervous system.

Introduction

The new coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) owing to its similarity to the previous severe acute respiratory syndrome (SARS), is a highly pathogenic and rapidly spreading virus.[1] Around 36% of patients in a Wuhan hospital presented neurological symptoms related to the virus, compromising the central nervous system (CNS), peripheral nervous system (PNS), and skeletal muscle.[2]

There have been several reports of patients who presented Guillain–Barré syndrome (GBS) related to COVID-19 with neurological affectation days or weeks after respiratory symptoms.[3] The prevalence is unclear and the total number of patients with concurrent GBS and COVID-19 remains unknown as more cases are published every day. Moreover, despite most of the patients having the typical motor/sensory syndrome, there are also case reports of other variants.[4] To our knowledge, 73 cases of adult patients suffering from GBS and SARS-CoV-2 infection[5–9] have been reported, most of them presenting motor and sensory syndrome.

To date, there are 17 reported cases in the literature of patients with GBS and facial nerve palsy associated with SARS-CoV-2 infection, most of them with limb compromise (that is ascending weakness, areflexia in the lower extremities, unsteady gait) and sensory symptoms (that is, ascending paresthesias, reduced sensation to pinprick).[6,10,11] Only one case reports bilateral facial palsy without other neurological findings.[10] In the present case report, we describe a patient previously diagnosed with COVID-19 who attended our hospital (Fundación CardioInfantil—FCI) with bilateral facial nerve palsy, a variant of Guillain–Barré syndrome known as facial diplegia. Given that previous reports of COVID-19-associated GBS have greater sensory and motor compromise in extremities, the present case has the particularity of having only bilateral facial nerve compromise. In contrast to previous reports of facial diplegia induced by SARS-CoV-2 infection, we included a complete neurophysiological test to characterize the type of nerve injury.

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