Guillain-Barré Syndrome, a Potential Complication of COVID-19

The major manifestations of COVID-19 are pulmonary. Nevertheless, neurologic disease may result, rarely through direct infection, less rarely through parainfectious complications, or more commonly via critical illness. In this series, five cases of Guillain-Barré syndrome (GBS) in patients with COVID-19 were seen in three hospitals in northern Italy from February 28 through March 21, 2020.

The first symptoms of GBS were lower limb weakness in four patients and facial diplegia with subsequent ataxia and paresthesia in one patient. Four patients had generalized flaccid tetraparesis or tetraplegia that developed over 3 to 4 days; three of these patients received mechanical ventilation. GBS symptoms began 5 to 10 days after the onset of COVID-19 symptoms. No patient had dysautonomic features. Protein levels in the cerebrospinal fluid (CSF), measured in two patients, were normal. In all five patients, white cell count was <5 per mm³ in all patients and real-time polymerase chain reaction assay of the CSF was negative for SARS-CoV-2. Electrophysiologic study results were consistent with axonal variant of GBS in three patients and with demyelination in two. All patients were treated with intravenous immune globulin and one also received plasma exchange. After 4 weeks of treatment, two patients remained in intensive care, two were receiving physical therapy, and one was discharged walking independently.