Guillain–Barré syndrome after an asymptomatic COVID‐19 Infection: a case report

Abstract

Background: Guillain–Barré syndrome (GBS) is an acute, immune-mediated generalized polyradiculoneuropathy often preceded by several infections. In most cases of GBS linked to SARS-CoV-2 worldwide, the infected individuals developed COVID-19 symptoms. This case report aims to present a case of a GBS post asymptomatic COVID-19 infection discovered in the emergency department of the regional hospital of Ksar Hellal.

Case Presentation: A 55-year-old man consulted the emergency department complaining of lumbar pain treated as a lumbar discal hernia. After 2 days, he developed acute weakness in the lower limbs. Neurological examination revealed a sensory-motor deficit in the lower limbs. The evolution was: absent deep tendon reflexes in the lower limbs, ascending flaccid symmetrical limb paralysis with tetraplegia, swallowing disorder, urinary incontinence, and central respiratory depression. A clinical diagnosis of GBS was made. The patient was transferred to the intensive care unit. He required invasive mechanical ventilation. Cerebrospinal fluid analysis revealed albumin cytologic dissociation. The serology was in favor of a recent COVID-19 infection. The patient was treated with intravenous immunoglobulin at 0.4 g/kg/day for 5 days. His clinical condition improved gradually. He was transitioned out of the intensive care unit after one month.

Conclusion: During the pandemic, all patients with suspected GBS should have SARS-CoV-2 tests to allow eventual rapid isolation. We expect an increase in the rate of GBS without an obvious cause, as long as one can have GBS after an asymptomatic COVID-19 infection. The doctor should be standing by to provide rapid, adequate assistance if required.