A UNIQUE CASE OF GUILLAIN-BARRÉ SYNDROME RELATED TO COVID-19 INFECTION

Abstract

SESSION TITLE: Fellows Critical Care Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: SARS-CoV2 causes a systemic infection, but pulmonary involvement is the main problem linked to SARS-CoV-2 infection(1). Neurological manifestations are increasingly reported in patients affected by COVID-19, including cases of encephalitis, stroke, and Guillain-Barre syndrome (2). We report a unique case of Guillain-Barre syndrome (GBS) in an immunocompromised patient with COVID-19 related respiratory failure who was failing weaning trial repeatedly. CASE PRESENTATION: A 59year old male with the history of splenectomy , Renal transplantation for End stage renal disease came with the chief complaints of confusion for 2 days. On arrival, the patient’s vitals were significant for hypoxia requiring supplemental oxygen via non-rebreather. CT head showed no acute intracranial pathology. His Chest X-ray revealed bilateral chest infiltrates. COVID-19 PCR on nasopharyngeal swab tested positive. His inflammatory markers were elevated and the patient received Convalescent Plasma and Tocilizumab. The patient’s mental status improved over next 3 days and he became oriented to time, place and person. The patient, however, had to be intubated on day 6 for worsening hypoxic respiratory failure. After 12 days of intubation, the patient was placed on weaning trial. He was able to open eyes during sedation breaks, however, was unable to follow commands or move extremities spontaneously or to painful stimuli. Repeat Head CT showed no acute changes. Electromyography revealed demyelinating axonal polyneuropathy. Lumbar puncture studies came out to be significant for elevated protein and minimal cell count (albumin-cytological dissociation). The Meningioencephalitis panel of Cerebrospinal fluid was negative. The patient has just completed five days of treatment with intravenous immunoglobulins. Due to the inability to wean him off the ventilator, he eventually underwent Tracheostomy and Peg tube placement procedure. DISCUSSION: Our case draws attention to the occurrence of GBS in patients with COVID-19 who are immunocompromised and does not experience motor or sensory symptoms before or at the time of intubation. In our case, GBS was suspected when our patient failed weaning trials. The mechanism of GBS in patients with COVID-19 is still unclear. Both SARS and COVID-19 attach to the angiotensin-converting enzyme 2 receptor which is present in cell membranes of numerous human organs including lung, liver, kidney, and nervous system (3). Guillain-Barré syndrome (GBS) is an acute/subacute immune-mediated polyradiculoneuropathy and may occur as a result of molecular mimicry. SARS-CoV-2 is known to cause an excessive immune reaction with an increased level of cytokines leading to extensive tissue damage (2). CONCLUSIONS: This must be known by clinicians as GBS may lead to failure of weaning trials in patient with COVID-19 and needs to be differentiated from a possible ICU-acquired weakness after ICU treatments. Reference #1: Guan WJ, Ni ZY, Hu Y et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Feb 28. doi: 10.1056/NEJMoa2002032. Reference #2: Carod-Artal FJ. Neurological complications of coronavirus and COVID-19. Rev Neurol. 2020;70(9):311-322. doi:10.33588/rn.7009.2020179 Reference #3: Sahin AR, Erdogan A, Mutlu Agaoglu P, Dineri Y, Cakirci AY, Senel ME, et al. 2019 Novel Coronavirus (COVID-Outbreak: A Review of the Current Literature. EJMO 2020;4(1):1-7.14 DISCLOSURES: No relevant relationships by Oleg Epelbaum, source=Web Response No relevant relationships by Anant Jain, source=Web Response No relevant relationships by Hamid Yaqoob, source=Web Response