Table 1.
Clinical and laboratory data.
| Case | Age and sex | COVID-19 related symptoms | Clinical symptoms and signs of GBS MRC at admission and time evolved | EGRIS | Laboratory findings | PCR | CT Chest | Co-morbidities | Treatment and Outcome |
|---|---|---|---|---|---|---|---|---|---|
| 1 | 34 Male |
10 days of fever, cough, expectoration | Flaccid areflexic quadriplegiay, stock and glove, hypothesia, bulbar palsy, respiratory failure → mechanical ventilator. MRC sum score: 0. The symptoms evolved over a week. |
6 | ↑D-dimer Leukocytosis, Anemia, Lymphopenia | –ve | Bilateral GGO | None | Five sessions plasmapheresis → no improvement. 1 month later → 5 days IVIG 2 weeks later → weaned from ventilator MRC sum score on discharge: 12 Two months after discharge MRC sum score improved to be 34 |
| 2 | 65 Male |
5 days of fever, malaise, cough | Flaccid areflexic quadriplegia, stock & glove hypothesia. MRC sum score: 12. The symptoms evolved over 2 days. |
14 | Neutropenia, Lymphopenia, ↓ PaCo2 & PaO2 |
+ve | Bilateral GGO | IHD, Cerebellar hemorrhage | 5 sessions of plasmapheresis → improvement MRC sum score on discharge: 48 |
| 3 | 49 Female |
3 days of fever and repeated vomiting | Flaccid areflexic quadriplegia, stock & glove hypothesia, Lt LMNL facial palsy, bilateral bulbar palsy, MRC sum score: 24 The symptoms evolved over 2 days. |
5 | ↑D-dimer, Thrombocytosis, Lymphopenia ↓ PaCO2 |
+ve | Bilateral GGO | None | 1 session of plasmapheresis → hypersensitivity reaction. 4 weeks later → 5 days IVIG. 1 week later → started to improve with MRC sum score on discharge: 36. Three weeks after discharge → she can walk with moderate support, MRC sum score 50 |
| 4 | 45 Male |
14 days of fever, cough, diarrhea | Flaccid areflexic quadriparesis, stock & glove hypothesia. MRC sum score: 40. The symptoms evolved over 1 day. |
4 | Anemia, Thrombocytosis, Neutrophilia, Lymphopenia | +ve | Bilateral GGO | DM | Steroids for 2 weeks → marked improvement MRC sum score on discharge: 60 but he still complains from paresethesia of fingers and toes |
| 5 | 55 Female |
14 days of fever, cough, expectoration | Bilateral LMN facial palsy, followed by flaccid areflexic quadriplegia with weakness proximal more than distal, as well as stock and glove hypothesia. MRC sum score: 34. The symptoms evolved over 10 days. |
4 | Leukocytosis, Neutrophilia, Lymphopenia. | Unavailable High IgG and IgM |
Bilateral GGO | None | Received 5 days of IVIG, and showed improvement on discharge that the patient walk with moderate support (MRC = 48). Two months later patient walk without support with the MRC sum score was 60 |
EGRIS, Erasmus GBS Respiratory Insufficiency Score RF, respiratory failure; LMNL, lower motor neuron lesion; MRC, Medical Research Council; Lap, laboratory results; PaCo2, partial pressure of carbon dioxide; PaO2, partial pressure of oxygen; PCR, Polymerase chain reaction from nasopharyngeal swap; -ve, negative; +ve, positive; CT, computerized tomography; GGO, Ground-glass Opacity; AIDP, acute inflammatory demyelinating polyneuropathy; IHD, Ischemic heart disease; DM, Diabetes mellitus; IVIG, Intravenous immunoglobulin. ↑, increase; ↓, decrease.