Guillain–Barre Syndrome Following SARS-CoV-2 Infection in Children

Abstract

Background: Guillain–Barre Syndrome (GBS) is an autoimmune polyneuropathy involving mainly motor but also sensory and autonomic nerves. It is considered postinfectious and is been linked with many infectious organisms such as human immunodeficiency virus, Zika virus, and others. Since the onset of the pandemic, a few cases of GBS with a temporal association with SARS-CoV-2 infection has been reported in adults and children. The manifestations are similar to the classic clinical phenotype of progressive, ascending, symmetrical flaccid paralysis of the limbs with areflexia/hyporeflexia, and with or without cranial nerve involvement. This series describe three children with post-COVID GBS. Case Description: Three unrelated boys, 14 years, 11 years, and 7 years in age presented with varying combinations of pain, paraesthesias, and ascending weakness involving their limbs for a few days. We suspected GBS based on the clinical phenotype of rapidly progressive symmetrical weakness. The Modified National Institute of Neurological Disorders and Stroke Criteria for establishing the clinical diagnosis of GBS were satisfied. The typical albuminocytological dissociation in cerebrospinal fluid was observed in all. Management: The GBS was presumed to be postinfectious secondary to the COVID-19 virus in each one, based on elevated COVID-19 immunoglobulin G (IgG) and IgM antibody titers, exclusion of other common infectious organisms, and normal magnetic resonance imaging. All these patients were started on intravenous immunoglobulin and methylprednisolone. Two children recovered without any neurological deficits. The third child expired due to respiratory involvement. Conclusion: COVID-19 infection may result in GBS, the clinical profile of which is similar to that seen after other infectious organisms.