tetano
Editor, Senior Moderator
Acta Neurol Belg
. 2021 Sep 2.
doi: 10.1007/s13760-021-01787-y. Online ahead of print.
SARS-CoV-2-associated Guillain-Barré syndrome in four patients: what do we know about pathophysiology?
Antoine Guilmot[SUP] 1 2 [/SUP], Sofia Maldonado Slootjes[SUP] 1 3 [/SUP], Véronique Bissay[SUP] 3 [/SUP], Nicolas Dubuisson[SUP] 1 4 [/SUP], Clémence de Broglie[SUP] 5 [/SUP], Michel Gille[SUP] 6 [/SUP]
Affiliations
Abstract
Background: A growing number of Guillain-Barré syndrome (GBS) and Miller Fisher Syndrome (MFS) cases following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are reported. Nevertheless, this association is still debated, and pathophysiology remains unclear.
Methods: Between April and December 2020, in three hospitals located in Brussels, Belgium, we examined four patients with GBS following SARS-CoV-2 infection.
Results: Neurological onset occurred 3 weeks after SARS-CoV-2 symptoms in all patients. Three patients presented with acute inflammatory demyelinating polyneuropathy (AIDP) and had negative anti-ganglioside testing: two suffered from a severe SARS-CoV-2 infection and had good clinical outcome after intravenous immunoglobulin (IVIG) treatment; one with mild SARS-CoV-2 infection had spontaneously favorable evolution without treatment. The fourth patient had critical SARS-CoV-2 infection and presented acute motor and sensory axonal neuropathy (AMSAN) with clinical features highly suggestive of brainstem involvement, as well as positive anti-ganglioside antibodies (anti-GD1b IgG) and had partial improvement after IVIG.
Conclusions: We report four cases of SARS-CoV-2-associated GBS. The interval of 3 weeks between SARS-CoV-2 symptoms and neurological onset, the clinical improvement after IVIG administration, and the presence of positive anti-ganglioside antibodies in one patient further support the hypothesis of an immune-mediated post-infectious process. Systematic extensive antibody testing might help for a better understanding of physiopathology.
Keywords: Anti-GD1b; Anti-gangliosides; Case series; Guillain–Barré syndrome; Pathophysiology; SARS-CoV-2.
. 2021 Sep 2.
doi: 10.1007/s13760-021-01787-y. Online ahead of print.
SARS-CoV-2-associated Guillain-Barré syndrome in four patients: what do we know about pathophysiology?
Antoine Guilmot[SUP] 1 2 [/SUP], Sofia Maldonado Slootjes[SUP] 1 3 [/SUP], Véronique Bissay[SUP] 3 [/SUP], Nicolas Dubuisson[SUP] 1 4 [/SUP], Clémence de Broglie[SUP] 5 [/SUP], Michel Gille[SUP] 6 [/SUP]
Affiliations
- PMID: 34476752
- DOI: 10.1007/s13760-021-01787-y
Abstract
Background: A growing number of Guillain-Barré syndrome (GBS) and Miller Fisher Syndrome (MFS) cases following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are reported. Nevertheless, this association is still debated, and pathophysiology remains unclear.
Methods: Between April and December 2020, in three hospitals located in Brussels, Belgium, we examined four patients with GBS following SARS-CoV-2 infection.
Results: Neurological onset occurred 3 weeks after SARS-CoV-2 symptoms in all patients. Three patients presented with acute inflammatory demyelinating polyneuropathy (AIDP) and had negative anti-ganglioside testing: two suffered from a severe SARS-CoV-2 infection and had good clinical outcome after intravenous immunoglobulin (IVIG) treatment; one with mild SARS-CoV-2 infection had spontaneously favorable evolution without treatment. The fourth patient had critical SARS-CoV-2 infection and presented acute motor and sensory axonal neuropathy (AMSAN) with clinical features highly suggestive of brainstem involvement, as well as positive anti-ganglioside antibodies (anti-GD1b IgG) and had partial improvement after IVIG.
Conclusions: We report four cases of SARS-CoV-2-associated GBS. The interval of 3 weeks between SARS-CoV-2 symptoms and neurological onset, the clinical improvement after IVIG administration, and the presence of positive anti-ganglioside antibodies in one patient further support the hypothesis of an immune-mediated post-infectious process. Systematic extensive antibody testing might help for a better understanding of physiopathology.
Keywords: Anti-GD1b; Anti-gangliosides; Case series; Guillain–Barré syndrome; Pathophysiology; SARS-CoV-2.