Guillain-Barré Syndrome and COVID-19: Two Case Reports

BACKGROUND: Since the outbreak of the coronavirus disease 2019 (COVID-19), which subsequently increased to a pandemic, the number of reports about neurological manifestations of the disease has increased. Guillain-Barre syndrome (GBS), which is acute paralytic neuropathy, is one such rare manifestation.
CASE REPORT: We report 2 cases of GBS in 58-year-old men with typical manifestations of COVID-19; one of them is presumed COVID-19. The interval between the onset of COVID-19 symptoms and the first symptoms of GBS was 5 and 13 days, respectively. The patients had a more severe GBS than in general cases of GBS associated with COVID-19; they required mechanical ventilation, and both patients developed sepsis and acute kidney injury (AKI), which led to the death of one of them. Serum antiganglioside antibodies were tested in 1 patient and were absent. A nerve conduction study also was performed in 1 patient and confirmed an acute inflammatory demyelinating polyneuropathy. One patient was treated with intravenous immunoglobulin and had a good prognosis, and the other was treated with plasma exchange and died.
CONCLUSIONS: Our cases demonstrate the clinical course of GBS in COVID-19, diagnostic findings, and treatment strategies. GBS associated with COVID-19 seems to share most features of other post-infectious GBS. Nevertheless, further research is required to fully understand the characteristics, pathogenesis, and management of GBS in COVID-19.

Keywords: Autoimmune Diseases of the Nervous System, Coronavirus Infections, COVID-19, Guillain-Barre Syndrome