ABSTRACT
Objective: Present a unique case of Guillain-Barre Syndrome after SARS-CoV-2 infection in the setting of multiple etiologies Background: There is currently a worldwide pandemic involving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more commonly known as coronavirus disease 19 (COVID-19). Due to the novelty of this disease, there is still much unknown about it. It has been commonly shown to affect the respiratory system, but can also have neurological manifestations. Guillain-Barre Syndrome (GBS) is an acute immune-mediated polyneuropathy. It is often preceded by infection, and likely due to the immune-response cross-reacting with peripheral nerves. Design/Methods: NA Results: A 70 year-old-male presents with complaints of bilateral lower extremity (BLE) weakness and paresthesia. About two months prior, he was positive for COVID-19 requiring intubation. Neurological examination was significant for BLE weakness proximal>distal, areflexia throughout BLE. CSF analysis showed albuminocytologic dissociation. Patient had allergic reaction to IVIG. Plasmapheresis for 5 doses showed mild improvement. CT abdomen/pelvis showed bilateral iliac seromas and right hematoma. Electromyography (EMG) and nerve conduction studies (NCS) showed active denervation of bilateral muscles supplied by the L2-L4 suggesting a radiculopathy/plexopathy. Patient underwent drainage of right hematoma, but not left due to poor window. Patient was discharged to a rehabilitation facility and will follow-up outpatient. Conclusions: As COVID-19 is a novel disease, there is much to be learned about it. It has been shown to lead to GBS. Although a clinical picture of symmetrical symptoms, areflexia, and albuminocytologic dissociation on CSF can support the diagnosis, a multifactorial etiology can exist. Bilateral L2-L4 radiculopathy/plexopathy due to compression was contributing this patient's symptoms. The development of bilateral compressive hematoma/seromas may have been related to COVID-19, as it can affect the complement cascade and coagulation system. It is important to keep a wide differential if treatment of GBS does not provide expected relief.