Post COVID-19 Gullain-Barre syndrome: an emerging neurological complication

ABSTRACT

A 45-year-old man presented to the Medicine Outdoor with chief complaints of tingling sensation of lower limbs followed by weakness of both lower and upper limbs of 5 days duration. His complaints started with tingling sensation on the dorsum of feet that progressed upwards and within 12 hours he developed weakness of both lower limbs that progressed to affect both upper limbs within 24 hours. About 15 days prior to this event, he had fever for 5 days with cough, sneezing, myalgia without anosmia and ageusia. He got relief of these symptoms with azithromycin and paracetamol without testing for Covid-19. On examination, he was afebrile, pulse rate of 80/min, Blood Pressure-130/80mm of Hg. In right arm supine posture, respiration rate-18/minute, oxygen saturation-97% at room air. In view of acute onset lower motor neuron type of quadriparesis without sensory deficit and sphincter involvement with a preceding history suggestive of upper respiratory tract infection (URTI) 2 weeks before, a clinical diagnosis of Post-infectious Gullain-Barre syndrome (GBS) was made. The detection of serum IgG to SARSCoV-2 which is in accordance with the time interval of antibody appearance i.e., within 13 median days of clinical onset suggested the antecedent Covid-19 that was limited to upper respiratory tract. Hence, final diagnosis of GBS after Covid-19 infection has been made and he was treated with intravenous Immunoglobin at a dose of 0.4g/kg/day for 5 days with a total dose of 2g/kg. He improved symptomatically and could walk without support and was discharged after 7 days.