Guillain Barre syndrome (GBS) refers to an acute onset polyradiculoneuropathy, which commonly manifests with rapidly progressive weakness of all 4 limbs, usually starting in lower limbs, then ascending to involve upper limbs. Muscle tone is reduced (hypotonia) and the deep tendon reflexes are either sluggish or absent. Minor sensory symptoms such as distal paresthesia and pain are common. Autonomic system involvement is uncommon. GBS usually occurs following a viral infection. Therefore, it is also referred to as post-infectious demyelinating polyradiculoneuropathy.
Recently, Chinese researchers reported a case of GBS (published in Lancet Neurology, April 1, 2020), with a history of travel from Wuhan. Patient presented with one day history of acute onset weakness, starting in lower limbs, which progressed to involve upper limbs within 3-4 days. DTRs were absent and muscle tone was reduced. She had no symptoms of fever, cough, chest pain or diarrhoea at onset. 3 days later, she worsened with decrease in muscle power and distal sensory loss. On day 4, CSF analysis showed normal cells, and high protein. On day 5, NCV studies confirmed a diagnosis of GBS, after which she was treated with intravenous immunoglobulins (IVIG).
On day 8, patient developed dry cough and fever. CT chest showed ground glass opacities in both lungs. Oro-pharyngeal swabs were positive for SARS CoV 2 on RT-PCR assay. She was shifted to isolation room and given supportive care along with antiviral drugs. Her condition gradually improved by 20, and she was near normal at discharge on day 30. Respiratory symptoms also improved.
- GBS can occur early and can be a presenting feature of SARS CoV 2 infection.
- The course of GBS in SARS CoV2 seems to be para-infectious (along with the infection), rather than the typical GBS, which is post-infectious (a few days after the infection)
- Treatment with IVIG results in good clinical outcome.