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Physicians in China are reporting what they believe is the first case of COVID-19 initially presenting as acute Guillain-Barre syndrome (GBS). The patient was a 61-year-old woman returning home from Wuhan during the pandemic.

"GBS is an autoimmune neuropathy, which could be triggered by various infections," corresponding author Sheng Chen, MD, PhD, Shanghai Jiao Tong University School of Medicine, China, told Medscape Medical News.

However, "Our single case report only suggests a possible association between GBS and SARS-CoV-2 infection. It may or may not have a causal relationship," Chen noted.

The case study was published online April 1 in Lancet Neurology.

The female patient returned from Wuhan on January 19 but denied having any fever, cough, chest pain, or diarrhea. She presented on January 23 with acute weakness in both legs and severe fatigue that progressed.

At presentation, temperature was normal, oxygen saturation was 99% on room air, and the patient's respiratory rate was 16 breaths per minute. She was not tested for SARS-CoV-2 at that point.

A neurologic examination revealed symmetric weakness (Medical Research Council grade 4/5) and areflexia in both legs and feet. The patient's symptoms had progressed 3 days after admission, and testing revealed decreased sensation to light touch and pinprick.

Admission laboratory test results indicated a low lymphocyte count and thrombocytopenia. Results of nerve conduction studies performed on day 5 of hospitalization were consistent with demyelinating neuropathy.

She was diagnosed with GBS and given intravenous immunoglobulin. On day 8, she developed a dry cough and fever, and a chest CT showed ground-glass opacities in both lungs. At this point, she was tested for SARS-CoV-2, and the results were positive.

The patient was immediately transferred to an isolation room and received supportive care and antiviral drugs. Her condition improved gradually, and her lymphocyte and thrombocyte counts were normalon day 20.

At discharge on day 30, she had normal muscle strength in both arms and legs, and tendon reflexes in both legs and feet had returned. Her respiratory symptoms had resolved as well. A second SARS-CoV-2 test was negative.

Two relatives of the patient who had been with her during her hospital stay also tested positive for SARS-CoV-2 and were isolated and treated.

All of the hospital staff that cared for the patient, including two neurologists and six nurses, tested negative for SARS-CoV-2.

Given the temporal association, SARS-CoV-2 infection could be responsible for the development of GBS in this patient, the investigators note. They add that the onset of GBS symptoms overlapped with the period of SARS-CoV-2 infection.

"Hence Guillain-Barre syndrome associated with SARS-CoV-2 might follow the pattern of a parainfectious profile, instead of the classic postinfectious profile, as reported in Guillain-Barre syndrome associated with Zika virus," the researchers write.

"More cases with epidemiological data are necessary to support a causal relationship" between SARS-CoV-2 infection and GBS, said Chen.

"However, we still suggest physicians who encounter an acute GBS patient from a pandemic area protect themselves carefully and test [for the] virus on admission. If the result is positive, the patient needs to be isolated," Chen said.

Lancet Neurol. Published online April 1, 2020. Full text

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First Case of COVID-19 Presenting as Guillain-Barr Reported - Medscape