Table 1.
Clinical characteristics and laboratory findings of three patients with Guillain–Barré syndrome after COVID‐19
| Case 1 | Case 2 | Case 3 | |
|---|---|---|---|
| Age/Gender | 52/Female | 63/Female | 61/Female |
| Comorbidities | None | Type 2 diabetes | None |
| Symptoms of COVID‐19 | Dry cough, fever, odynophagia, arthralgia, diarrhoea | Dry cough, shivering, odynophagia, breathing difficulties, chest pain | Productive cough, fever, myalgia, vasovagal syncope, diarrhoea, nausea and vomiting |
| Method for COVID‐19 diagnosis | Antibodies for SARS‐CoV‐2 IgM/IgG, followed by RT‐PCR positive in nasopharyngeal swab (4th test) | RT‐PCR in nasopharyngeal swab (2nd test) | RT‐PCR in nasopharyngeal swab |
| Neurological signs and symptoms |
Back pain, limb weakness, ataxia, distal paresthesia, dysgeusia, cacosmia. Developed respiratory failure, dysautonomia and tetraplegia with areflexia (day 4) |
Lower limb pain, mild weakness and normal deep tendon reflexes. Developed tetraparesis, distal paresthesia and areflexia (day 5) | Lower limb weakness and distal paresthesia, dizziness, dysphagia, dysautonomia, areflexia. Presented worsening of bulbar symptoms and bilateral facial palsy (day 4) |
| Time of neurological symptom onset (days) | 15 | 7 | 22 |
| Cerebrospinal fluid findings | WBC 3 cell/µl; Protein level 60 mg/dl; Negative PCR assay for SARS‐CoV‐2 (day 2) | WBC 2 cell/µl; Protein level 40 mg/dl; PCR assay for SARS‐CoV‐2 was not performed (day 6) | WBC 4 cell/µl; Protein level 140 mg/dl; Negative PCR assay for SARS‐CoV‐2 (day 1) |
| Serum studies | WBC 8900 cells/mm3; Lymphocytes 1200 cells/mm3; Platelets 45 500 cells/mm3. Normal kidney and liver function. Antibodies to ganglioside panel a were negative | WBC 3300 cells/mm3; Lymphocytes 800 cells/mm3; Platelets 119 000 cells/mm3. Normal kidney function. Elevated transaminase levels (AST 65 U/l; N < 45 U/l). Antibodies to ganglioside panel a were not performed | WBC 4000 cells/mm3; Lymphocytes 600 cells/mm3; Platelets 322 000 cells/mm3. Normal kidney and liver function. Hyponatremia (127 mmol/l). Antibodies to ganglioside panel a were not performed |
| MRI results | Spinal cord: no nerve root gadolinium enhancement | Not performed | Spinal cord: lumbosacral nerve root enhancement. Normal brain imaging |
| Treatment | 1 cycle of IVIg (day 2) | 1 cycle of IVIg (day 10) | 1 cycle of IVIg (day 2) |
| Clinical outcome at 5 weeks | Improvement of tetraparesis. Able to stand up with assistance. GBS disability clinical score 4/6 | Dismissal with full motor recovery. Persistence of lower limb areflexia and distal paresthesia. GBS disability clinical score 1/6 | Improvement of tetraparesis and ability to walk with assistance. Persistence of neuropathic pain and distal paresthesia. GBS disability clinical score 3/6 |
AST, aspartate transaminase; COVID‐19, coronavirus disease 2019; GBS, Guillain–Barré syndrome; IVIg, intravenous immunoglobulins; MRI, magnetic resonance imaging; RT‐PCR, reverse transcription polymerase chain reaction; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2; WBC, white blood cell count.
a
Anti‐ganglioside antibodies panel includes anti‐GM1, GD1a and GQ1b.