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CASE REPORT
Year : 2022  |  Volume : 25  |  Issue : 2  |  Page : 200-202

Intensive care management in guillain barré syndrome accompanying prolonged Covid-19–A case report


Department of Anesthesiology and Reanimation, Karabük University Training and Research Hospital, Karabük, Turkey

Date of Submission20-Feb-2021
Date of Acceptance11-Jun-2021
Date of Web Publication16-Feb-2022

Correspondence Address:
Dr. E Toy
Department of Anesthesiology and Reanimation, Karabük University Training and Research Hospital - 78050, Karabük
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_85_21

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   Abstract 


One of the neurological complications associated with COVID-19 is Guillain Barre Syndrome (GBS). It is possible to be a complication of COVID19 due to the similarity of respiratory complication between both clinical entities. The aim of this case report is to present a case followed in the intensive care unit (ICU) with the coexistence of prolonged COVID-19 and GBS. The 68-year-old patient, whose COVID-19 symptoms had been going on for 5 weeks, was followed for 5 days in the ICU due to GBS diagnosis. During this period, the patient's symptoms regressed with IVIG treatment. ICU physicians should be careful that some neurological complications may accompany in some prolonged COVID-19 cases and that one of these may be GBS.

Keywords: Guillain Barre syndrome, intensive care management, prolonged COVID-19


How to cite this article:
Toy E, Kart K. Intensive care management in guillain barré syndrome accompanying prolonged Covid-19–A case report. Niger J Clin Pract 2022;25:200-2

How to cite this URL:
Toy E, Kart K. Intensive care management in guillain barré syndrome accompanying prolonged Covid-19–A case report. Niger J Clin Pract [serial online] 2022 [cited 2022 Dec 2];25:200-2. Available from: https://www.njcponline.com/text.asp?2022/25/2/200/337772




   Introduction Top


T he term “Prolonged COVID” is used to describe the disease in individuals who have recovered from COVID-19, but have persistent effects of the infection for a while or have usual symptoms for longer than expected.[1]

COVID-19 may cause multiple systemic infections. The most common symptoms at the onset of the disease are fever, cough, shortness of breath, myalgia, headache or diarrhea. It causes respiratory complications the most.[2] Some neurological complications due to COVID-19 infection have been reported in some studies.[3],[4] Guillain Barre Syndrome (GBS) is less known neurological symptoms associated with COVID-19. The incidence of GBS in COVID-19 has been reported as 0.3%-0.4% in some cases.[3],[4]

This case report presents a case followed in the intensive care unit (ICU) with a coexistence of prolonged COVID-19 and GBS. The aim of the case report is to share ICU experience regarding this rare case.


   Case Report Top


A 68-year-old male patient was brought to the emergency service with complaints of back pain, weakness, fatigue, symmetrical weakness in the legs that lasted for 10 days and inability to walk for the last 4 days. It was learned from the patient's anamnesis that he had hairy cell leukemia for two years and he was not receiving treatment, he had received treatment of favipiravir, immune plasma and corticosteroid since he had COVID-19 5 weeks ago and he was discharged from the hospital after 10-day long treatment was completed. The patient's complaints of loss of smell and fatigue had been continuing since he was diagnosed with COVID-19.

The patient was diagnosed with GBS by neurological imaging, lumbar puncture and electrodiagnostic tests. The reverse transcriptase polymerase chain reaction (PCR) test from swab sample was found to be positive for COVID-19, the patient was thought to have prolonged COVID-19 and was admitted to ICU where COVID-19 patients were followed.

When the patient was admitted in ICU, he was conscious and cooperative. He was tachypneic and dyspneic; respiratory sounds were mildly decreased in the basal parts of both lungs. Peripheral oxygen saturation (SpO2) was 86%, respiratory rate was 18/min, arterial blood pressure was 138/75 mmHg, pulse rate was 80/min and fever was 36.8°C. In both lower extremities, muscle power was 2/5 at the distal and 3/5 at the proximal according to Medical Research Council (MRC) scale. Both lower extremities had areflexia, numbness and tingling. There was no superficial sensory defect. In the upper extremity, muscle power was 4/5 according to MRC scale. No loss of sensation was found in the upper extremity. Protein level was found to increase in the patient's cerebrospinal fluid (CSF) evaluation (100.1 mg/dL). COVID-19 PCR test was found to be negative in CSF sample. There was no microorganism growth in CSF and no leukocytes were found.

SpO2 was provided to be above 90% by starting oxygen support to the patient with a reservoir mask at a flow rate of 5L/min. In addition to treatment given due to respiratory symptoms, intravenous immunoglobulin (IVIG) treatment was started. In his daily follow-ups, muscle strength was found to increase every day. After receiving a total of 5 days of IVIG treatment, lower extremity muscle strength was found as 5/5 according to MRC scale. The patient, whose respiratory symptoms and oxygen need decreased, was discharged from ICU. The patient's PCR test became negative approximately 9 weeks after and was discharge.


   Discussion Top


GBS is an important disease that can cause severe symptoms ranging from progressive muscle weakness to respiratory distress. GBS is a neurological disease separate from COVID19. It is possible to be a complication of COVID19 due to the similarity of respiratory complication between both clinical entities.[5]

In this case report, a case followed due to prolonged COVID-19 and GBS is presented.

COVID-19 can be encountered in different clinical pictures ranging from asymptomatic carriers to severe pneumonia and multi-organ failure. In a study[6] conducted with 4182 patients diagnosed with COVID-19, it was reported that some symptoms continued after 28 days in 13% cases. These symptoms have been reported as fatigue, headache, dyspnea and anosmia and increased age, body mass index and female gender have been found to increase the probability of prolonged COVID-19.[6] Fatigue and anosmia complaints of the presented case had not recovered for 5 weeks and COVID-19 PCR test positivity was still continuing 5 weeks later.

The most frequently reported central nervous system complaints in COVID-19 are dizziness and headache, while the most frequently reported peripheral nervous system complaints are decreased sense of taste and hyposmia.[1],[4] Persistence of anosmia in the presented case suggests that the disease has neurological involvement.

The first GBS cases associated with COVID-19 were reported from China and Iran in April 2020. In one of these cases, the authors discussed about whether the association between of COVID-19 and GBS was casual or random.[7],[8]

Although the cause of GBS is not known exactly, it is associated with triggering events such as viral or inflammatory diseases. The symptoms of the disease reach the highest level in 2-4 weeks and recovery period may last for weeks.[9] In the present case report, GBS symptoms thought to be associated with COVID-19 reached the highest level approximately 5 weeks after the infection. The case had mild respiratory symptoms, but he did not require mechanical ventilation. The patient's respiratory distress was thought to be compatible with radiographic images and it was not attributed to a neurological cause.

While GBS caused by COVID-19 may affect people of all ages, it has been reported more frequently in men. Patients' COVID-19 PCR tests from CSF sample was negative. It has been reported that more than 70% of patients showed good prognosis after IVIG treatment.[10] The presented case was a 68-year-old male patient and his symptoms regressed in a short time with IVIG treatment.

Care should be taken in terms of neurological symptoms that may develop in patients hospitalized in ICU due to COVID-19. In patients followed in ICU, GBS development may affect the patient's respiratory and vital capacity. Such an effect can be considered if the patient's respiratory failure is not proportional to the severity of the disease.

Declaration of patient consent

The authors confirm that they have received patient consent form. In the form, the patient's legal representative has given permission for the patient's clinical information to be reported in the journal. The patient and the patient's representative understand that their names and initials will not be published and that every effort will be made to conceal their identities, but their anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mahase E. Covid-19: What do we know about “long covid”? BMJ 2020;14:370.  Back to cited text no. 1
    
2.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 2
    
3.
Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. Guillain–Barré syndrome associated with SARS-CoV-2. N Engl J Med 2020;382:2574-6.  Back to cited text no. 3
    
4.
Özdağ Acarlı AN, Samancı B, Ekizoğlu E, Çakar A, Şirin NG, Gündüz T, et al. Coronavirus disease 2019 (COVID-19) from the point of view of neurologists: Observation of neurological findings and symptoms during the combat against a pandemic. Arch Neuropsychiatry 2020;57:154-9.  Back to cited text no. 4
    
5.
Baig AM. Neurological manifestations in COVID-19 causedby SARS-CoV-2. CNS Neurosci Ther 2020;26:499-501.  Back to cited text no. 5
    
6.
Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC, et al. Attributes and predictors of long COVID. Nat Med 2021;27:626-31.  Back to cited text no. 6
    
7.
Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: Causality or coincidence?. Lancet Neurol 2020;19:383-4.  Back to cited text no. 7
    
8.
Sedaghat Z, Karimi N. Guillain Barre syndrome associated with COVID-19 infection: A case report. J Clin Neurosci 2020;76:233-5.  Back to cited text no. 8
    
9.
Khan F, Ng L, Amatya B, Brand C, Turner-Stokes L. Multidisciplinary care for Guillain-Barré syndrome. Eur J Phys Rehabil Med 2011;47:607-12.  Back to cited text no. 9
    
10.
Abu-Rumeileh S, Abdelhak A, Foschi M, Tumani H, Otto M. Guillain–Barré syndrome spectrum associated with COVID-19: An up-to-date systematic review of 73 cases. J Neurol 2020;25:1-38.  Back to cited text no. 10
    




 

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