Herpes Simplex/Epstein Barr Virus Reactivation in a Patient with Guillain-Barre Syndrome Secondary to COVID-19 Pneumonia

ABSTRACT

Case Diagnosis Guillain-Barre Syndrome secondary to COVID-19 pneumonia complicated by reactivation of Herpes Simplex and Epstein-Barr virus causing ventriculitis/ encephalitis Case Description or Program Description 64 y/o male admitted to acute care hospital (ACH) with progressive bilateral lower extremity weakness associated with recent "flu-like" symptoms and positive COVID-19 test. ACH course was complicated by flaccid tetraplegia, hypoxemic respiratory failure and altered mental status. Initial CSF studies revealed elevated protein with albuminocytologic dissociation, negative cultures and negative viral panel, consistent with Guillain Barre Syndrome (GBS) in the setting of recent COVID-19 pneumonia. Patient was treated with plasmapheresis and IV corticosteroids with no neurological improvement. Setting(s) Inpatient rehab Assessment/Results: Patient then developed visual loss and was diagnosed with cortical blindness that could not be explained by his underlying GBS. MRI brain revealed findings consistent with ventriculitis/ encephalitis. Repeat CSF studies revealed positivity for Herpes Simplex Virus (HSV-2) as well as Epstein-Barr virus, both of which were previously undetected on admission. Patient was transferred to acute inpatient rehabilitation facility (IRF) with flaccid tetraplegia, cortical blindness, pressure ulcers, malnutrition at a total assist level of function. During IRF stay majority of rehab efforts were focused on training family to care for his various needs;tube feeds, medications, avoiding pressure ulcers. Discussion (relevance) The initial negative CSF studies and sequential development of this patient's symptoms are evidence to support that the COVID-19 virus can likely cause reactivation of other viruses. One study, "Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation", reported that up to 66.7% of COVID-19 patients were found to be positive for EBV reactivation. In our patient, the reactivation of HSV-2 and EBV causing ventriculitis/ encephalitis with cortical blindness had major implications on his rehabilitation outcomes. Conclusion(s) To date, there has been minimal published research on the potential of COVID-19 to cause reactivation of other viruses. This case report emphasizes the remarkable ability of the COVID-19 virus to reactivate other viruses and also provides an example of the clinical implications of this within acute rehabilitation.