Disclosures: Jason Lew, DO: No financial relationships or conflicts of interest

Case Diagnosis: Asymmetric acute inflammatory demyelinating polyneuropathy as presenting symptom of COVID-19 infection.

Case Description or Program Description: A 54-year-old male with history of alcohol use with five-day history of left leg weakness with progression to numbness and weakness to the left side of his face. He then developed right sided weakness, more severe than his left side, primarily distally, as well as numbness and tingling into his bilateral hands. Imaging was negative for acute cause of his symptoms. He did test positive for COVID-19 but was asymptomatic except for occasional dry cough one week prior. His symptoms were initially thought to be from peripheral neuropathy secondary to alcohol use, however he then developed new dysarthria and dysphagia.

Setting: Acute Inpatient Rehabilitation Hospital

Assessment/Results: MRI brain, CTA head and neck, CT cervical spine were negative for acute causes of weakness. Negative HIV and paraneoplastic panel. Lumbar puncture showed albuminocytologic dissociation consistent with Guillain-Barré Syndrome (GBS) . Electrodiagnostic testing is scheduled and pending at this time.

Discussion (relevance): GBS generally presents as a symmetric, ascending weakness secondary to a potential viral attack on myelin and Schwann cells. GBS can rapidly ascend and cause autonomic and respiratory failure, so early and accurate diagnosis and treatment are essential. This case demonstrates GBS related to COVID-19 with minimal other symptoms. It also demonstrates the importance of thorough investigation of the potential differentials for neuropathy, as this patient’s diagnosis was initially thought to be from alcohol use, which can lead to inappropriate treatment with worse outcomes. In this case, there was a lower suspicion for GBS given its unusual presentation and non-definitive association with COVID-19 infection.

Conclusions: There is growing research of a positive correlation between COVID-19 infection and GBS, which is further supported by this case with unusual presentation of asymmetric GBS. Continued research is needed to determine the risk of GBS with COVID-19 infection.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/asymmetric-guillain-barre-syndrome-as-primary-presentation-of-minimally-symptomatic-covid-19-infection/