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Journal Information
Vol. 35. Issue 4.
Pages 268-269 (May 2020)
Vol. 35. Issue 4.
Pages 268-269 (May 2020)
Letter to the Editor
DOI: 10.1016/j.nrleng.2020.04.006
Open Access
Guillain-Barré syndrome associated with SARS-CoV-2 infection
Síndrome de Guillain-Barré asociado a infección por SARS-CoV-2
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A. Velayos Galán, P. del Saz Saucedo
Corresponding author
albertovelayosgalan@gmail.com

Corresponding author.
, F. Peinado Postigo, E. Botia Paniagua
Servicio de Neurología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
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Dear Editor:

COVID-19 is an infectious disease caused by a novel coronavirus, SARS-CoV-2. The virus was first detected in Wuhan, China, in December 2019, and subsequently spread across the world.1 There is extensive evidence that SARS-CoV-2 infection causes respiratory alterations; however, the associated neurological manifestations are less well-known.2 We present a case of Guillain-Barré syndrome (GBS) associated with COVID-19.

Our patient is a 43-year-old man who consulted due to symmetrical weakness involving all 4 limbs; weakness progressively increased in severity, leading to inability to walk. He also presented sensory alterations in distal regions of all 4 limbs. Ten days previously he had experienced a self-limited episode of diarrhoea, followed by symptoms of upper respiratory tract infection.

The neurological examination revealed weakness in all 4 limbs, with 3/5 muscle strength proximally and 4/5 distally, and global areflexia. Chest radiography revealed alterations suggestive of incipient pneumonia secondary to COVID-19 (Fig. 1). The PCR test for SARS-CoV-2 returned positive results. An EMG/nerve conduction study revealed increased distal motor latency and decreased sensory nerve conduction velocity in the nerves evaluated, and increased minimal F-wave latency in the right L5 and S1 spinal nerve roots; these findings are suggestive of demyelinating polyradiculoneuropathy and compatible with a diagnosis of GBS.

Figure 1.

Chest radiography (posteroanterior view) revealing ground-glass opacity in the right middle lobe; in the current epidemiological situation, these findings suggest incipient pneumonia secondary to SARS-CoV-2 infection.

(0.06MB).

During hospitalisation, the patient was assessed by the pulmonology and neurology departments. He received intravenous immunoglobulins for 5 days plus protocolised treatment for COVID-19: hydroxychloroquine sulfate, antiretroviral drugs (lopinavir and ritonavir), antibiotics (amoxicillin), corticosteroids, and low-flow oxygen therapy. Motor function worsened within 2 days of admission, with the patient developing bilateral facial palsy and dysphagia. Subsequently, neurological and respiratory symptoms progressed favourably.

Although SARS-CoV-2 infection is likely to have caused GBS in our patient, we should not rule out the possibility that co-presence of GBS and SARS-CoV-2 infection may be coincidental. The association between COVID-19 and GBS has not been established, although recent evidence suggest that the virus may be involved in the aetiopathogenesis of GBS.3 Future studies should address the neurological manifestations of SARS-CoV-2 infection.

References
[1]
C.C. Lai, T.P. Shih, W.C. Ko, H.J. Tang, P.R. Hsueh.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges.
Int J Antimicrob Agents, 55 (2020), pp. 105924
[2]
J. Matías-Guiu, U. Gomez-Pinedo, P. Montero-Escribano, P. Gomez-Iglesias, J. Porta-Etessam, J.A. Matías-Guiu.
¿Es esperable que haya cuadros neurológicos por la pandemia por SARS-CoV-2?.
Neurologia, 35 (2020), pp. 170-175
[3]
H. Zhao, D. Shen, H. Zhou, J. Liu, S. Chen.
Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence?.
Lancet Neurol, 19 (2020), pp. 383-384

Please cite this article as: Galán AV, del Saz Saucedo P, Peinado Postigo F, Botia Paniagua E. Síndrome de Guillain-Barré asociado a infección por SARS-CoV-2. Neurología. 2020;35:268–269.

Copyright © 2020. Sociedad Española de Neurología
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