ABSTRACT
OBJECTIVE: Single cases and small series of Guillain-Barré syndrome (GBS) have been reported during the SARS-CoV-2 outbreak worldwide. We evaluated incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of patients with COVID-19. METHODS: GBS cases diagnosed in 12 referral hospitals from Lombardy and Veneto in March and April 2020 were retrospectively collected. As a control population, GBS diagnosed in March and April 2019 in the same hospitals were considered. RESULTS: Incidence of GBS in March and April 2020 was 0.202/100 000/month (estimated rate 2.43/100 000/year) vs 0.077/100 000/month (estimated rate 0.93/100 000/year) in the same months of 2019 with a 2.6-fold increase. Estimated incidence of GBS in COVID-19-positive patients was 47.9/100 000 and in the COVID-19-positive hospitalised patients was 236/100 000. COVID-19-positive patients with GBS, when compared with COVID-19-negative subjects, showed lower MRC sum score (26.3±18.3 vs 41.4±14.8, p=0.006), higher frequency of demyelinating subtype (76.6% vs 35.3%, p=0.011), more frequent low blood pressure (50% vs 11.8%, p=0.017) and higher rate of admission to intensive care unit (66.6% vs 17.6%, p=0.002). CONCLUSIONS: This study shows an increased incidence of GBS during the COVID-19 outbreak in northern Italy, supporting a pathogenic link. COVID-19-associated GBS is predominantly demyelinating and seems to be more severe than non-COVID-19 GBS, although it is likely that in some patients the systemic impairment due to COVID-19 might have contributed to the severity of the whole clinical picture.
Subject(s)
COVID-19/complications , Guillain-Barre Syndrome/epidemiology , Adult , Aged , COVID-19/diagnosis , COVID-19/therapy , Female , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/therapy , Hospitalization , Humans , Incidence , Italy , Male , Middle Aged , Referral and Consultation , Retrospective StudiesABSTRACT
BACKGROUND: The outbreak of the coronavirus disease 2019 (COVID-19) has had profound impact on health care not only for its direct effects, but also because it deeply influenced the whole clinical practice and diagnostic pathways, particularly in the acute setting. CASE REPORT: We present the case of a patient with respiratory dysfunction due to myasthenia gravis (MG) initially misdiagnosed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to ambiguity in the interpretation of radiological and microbiological findings during COVID-19 pandemic. DISCUSSION: Respiratory dysfunction as first clinical manifestation of myasthenia gravis is rare, but potentially very harmful. Emergency physicians should always consider neurological diseases when dyspnea cannot be explained by cardiac or respiratory causes.