A case report of Guillain–Barré syndrome in a pregnant woman infected by COVID-19

Abstract

Guillain–Barré syndrome (GBS) is a rare condition caused by the immune system attacking peripheral nerves resulting in the demyelination of nerve cells, manifested by muscle weakness and paresthesia [1]. People with GBS may be at higher risk of infection by COVID-19 than those in the general population. The present case reports on GBS as observed in a pregnant woman following a mild symptomatic COVID-19 infection. In mid-November 2020, a 29-year-old pregnant woman presented with an initial complaint of tingling sensations in the distal aspect of all four limbs and mild weakness in the lower limbs that began the day before. The patient was a gravid 1, 18–19-week, pregnant woman. She had no history of any specific neurologic or rheumatic diseases and her vital signs were within the normal range. She had flu-like symptoms such as fever, chills, myalgia, headaches, and a runny nose which began about 10 days before her presentation but she had not seen a doctor due to her concerns about COVID-19 exposure during the pandemic while pregnant. She was reviewed by the gynecology and obstetrics team, and neurology services upon arrival in the emergency room. On examination, DTRs were absent and vibration sense was reduced in her lower limbs. There was no urinary retention and no spinal sensory level was detected. Muscle power was reduced to 2/5 in her lower limbs, but remained normal in her upper limbs; the findings were suggestive of progressive symmetrical ascending weakness. Following the initial diagnosis of GBS, the patient was admitted to the intensive care unit and was scheduled to receive 0.4 g/kg/day of IVIg. Before receiving the IVIg, blood samples were taken to perform the necessary tests. Nasopharyngeal and oropharyngeal samples were sent for SARS-CoV-2 polymerase chain reaction (PCR). EMG–NCV was ordered for this patient. On the second day of hospitalization the patient experienced dysphagia and nasal speech, with tachycardia (121/ min). Other vital signs were normal. SARS-CoV-2 PCR was reported as negative while anti-SARS-CoV-2 IgG and IgM * Maliheh Arab [email protected]