Disclosures: Alexandra Beling, MD: No financial relationships or conflicts of interest

Case Diagnosis: Covid-19 Pneumonia with Guillain Barre Syndrome.

Case Description or Program Description: A 53-year-old female with history of tobacco use presented to the ED after a week of bilateral leg weakness, ascending to the arms, and difficulty swallowing. Covid test was incidentally positive. She had 1+ upper extremity and absent lower extremity reflexes, and was admitted with clinical diagnosis of Guillain Barre Syndrome (GBS). Patient was pre-medicated with lorazepam and diphenhydramine prior to initiation of IVIG. Ten minutes into the infusion, she became acutely and persistently hypoxemic, requiring transfer to ICU with intubation and proning. CT Chest showed bilateral aspiration with collapse of posterior lobes. Thus, respiratory failure attributed to bulbar weakness. GBS was later confirmed by LP, EMG, and MRI Spine.

Setting: Tertiary to inpatient rehabilitation hospital.

Assessment/Results: Patient completed 5 day course of IVIG, and empiric treatment with Dexamethasone and Remdesivir. Her course was complicated by two bacterial pneumoniae and failed extubation requiring tracheostomy. At time of transfer to inpatient rehab, she received her first Covid vaccine and experienced only commonly reported side effects. She was successfully decannulated. Patient made excellent progress with PT and OT, progressing from Moderate Assistance to Independent levels. She had residual right plantarflexion weakness that benefited from a posterior leaf spring (PLS) brace. She ultimately discharged home with family.

Discussion (relevance): Development of GBS with a Covid-19 infection or post-vaccination has been described in the literature, but as this case demonstrates, temporal association does not imply causation. Furthermore in this case, decreased mental status due to sedating medications in the setting of dysphagia led to massive aspiration, leading to a prolonged hospital course.

Conclusions: In Covid patients with concurrent GBS, heightened vigilance is required for rapidly weakening swallowing and respiratory muscle dysfunction, compromising Covid-infected lungs. Special attention is necessary for the medical care and rehabilitation of these dual diagnosis patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/association-or-causation-rehabilitation-of-a-patient-with-concurrent-covid-19-pneumonia-and-guillain-barre-syndrome-a-case-report/