COVID-19 and Guillain-Barré Syndrome

May 11, 2020 by Sam Bazzi

This week I would like to focus on Guillain-Barré Syndrome (GBS) and the published reports on the association between GBS and COVID-19. GBS is a rare neurological autoimmune disorder that affects the peripheral immune system, characterized by sensory deficits, and in some cases leading to acute paralysis and neuromuscular respiratory failure. A case study from Italy was recently published in Neurology: Neuroimmunology & Neuroinflammation, describing  an older patient who was diagnosed with GBS following COVID-19 infection (Alberti, et al., 2020). The patient was a 71-year-old man who initially presented with paresthesias (burning or prickling sensation in extremities). The paresthesias quickly evolved into a severe flaccid quadriparesis. On neurological exam, the patient retained normal consciousness and language skills and had no cranial nerve deficits. He was noted to have a stocking-and-glove hypesthesia and severe hypoxia on arterial blood gas evaluation. Brain CT scan was normal, but a chest CT scan revealed ground glass opacities typically seen in COVID-19. This workup prompted SARS-CoV-2 testing, which came back positive. The symptoms were interpreted as an acute form of polyradiculoneuritis with demyelinating features and the diagnosis of GBS associated with COVID-19 was made. Shortly afterwards, the patient developed severe respiratory failure and did not survive.

This case highlights the varied neurological presentations of COVID-19 as well as the need for more research to understand  the association between viral infections and autoimmunity, particularly with GBS. Two-thirds of patients with GBS typically describe preceding symptoms of respiratory or gastrointestinal infection within four weeks of onset of the syndrome (Willison, Jacobs, von Doorn, 2016). Additionally, GBS is associated with gastrointestinal infections, such as Campylobacter jejuni, and other viruses, such as cytomegalovirus and Zika (Cao-Lormeau, et al., 2016, Visser, et al., 1996). Despite being generally rare, GBS’s strong association with preceding infections may shed light on how autoimmunity develops. Additionally, because GBS symptoms tend to resolve with time, it would be interesting to compare this condition to other autoimmune disorders where autoimmunity remains permanent. Perhaps particular viruses cause acute autoimmunity in some cases and chronic autoimmunity in others.

Written by: Sam Bazzi
Edited by: Jina Zhou and Esther Melamed
5/11/2020