First Case of Guillain-Barre Syndrome Linked to COVID-19

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As case numbers of COVID-19 continue to rise around the world, we are starting to see an increasing number of reports of neurological symptoms. Some studies report that over a third of patients show neurological symptoms. COVID-19 is a respiratory infection that causes fever, aches, tiredness, sore throat, cough and, in more severe cases, shortness of breath and respiratory distress. We now understand that COVID-19 can also infect cells outside of the respiratory tract and cause a wide range of symptoms from gastrointestinal disease (diarrhea and nausea), as well as heart damage, blood clotting disorders, and now, neurological symptoms. Several recent studies have identified the presence of neurological symptoms in COVID-19 cases. Several reports have described COVID-19 patients suffering from Guillain–Barré syndrome. Guillain–Barré syndrome is a neurological disorder where the immune system responds to an infection and ends up mistakenly attacking nerve cells, resulting in muscle weakness and eventually paralysis. The Lancet has published a report on April 1, 2020 that details a case of Guillain–Barré syndrome from COVID-19 after recent travel to Wuhan, China. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), originating from Wuhan, is spreading around the world and the outbreak continues to escalate. Patients with coronavirus disease 2019 (COVID-19) typically present with fever and respiratory illness.1 However, little information is available on the neurological manifestations of COVID-19. Here, we report the first case of COVID-19 initially presenting with acute Guillain-Barré syndrome. On Jan 23, 2020, a woman aged 61 years presented with acute weakness in both legs and severe fatigue, progressing within 1 day. She returned from Wuhan on Jan 19, but denied fever, cough, chest pain, or diarrhoea. Her body temperature was 36·5°C, oxygen saturation was 99% on room air, and respiratory rate was 16 breaths per min. Lung auscultation showed no abnormalities. Neurological examination disclosed symmetric weakness (Medical Research Council grade 4/5) and areflexia in both legs and feet. 3 days after admission, her symptoms progressed. Muscle strength was grade 4/5 in both arms and hands and 3/5 in both legs and feet. Sensation to light touch and pinprick was decreased distally. In conclusion, the report noted that "Overall, this single case report only suggests a possible association between Guillain-Barré syndrome and SARS-CoV-2 infection, and more cases with epidemiological data are necessary to support a causal relationship. This case also suggests the need to consider potential neurological symptoms of SARS-CoV-2 infection. Furthermore, this report should alert clinicians to the risk of inadvertent SARS-CoV-2 infection, even if they work outside of the emergency or infectious disease department."

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