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HomeJournal of Medical Case Reportsindex/list_12208_1Guillain–Barré/Miller Fisher Overlap Syndrome in a Patient After Coronavirus Disease-2019 Infection

Guillain–Barré/Miller Fisher Overlap Syndrome in a Patient After Coronavirus Disease-2019 Infection

Abstract and Introduction

Abstract

Background: Beyond the typical respiratory symptoms associated with novel coronavirus, increasing evidence has been reported of the neurological manifestations affecting both the central and peripheral nervous systems.

Case Presentation: We observed a 30-year-old Persian woman developing acute motor sensory axonal neuropathy, a variant of Guillain–Barré syndrome that overlaps Miller Fisher syndrome, 30 days after confirmed coronavirus disease-2019 infection. Our case highlight the rare occurrence of Guillain–Barré syndrome overlapping with Miller Fisher during the coronavirus disease-2019 pandemic. These neurologic manifestations may occur because of an aberrant immune response to coronavirus disease-2019.

Conclusions: The early recognition of Guillain–Barré syndrome symptoms is critical, given the associated severe motor disabilities that may seriously limit the quality of life of these patients. We may still have much to learn about the co-occurrence of Guillain–Barré syndrome and Miller Fisher to improve the quality of life of these patients requiring an accurate evaluation by neurologists.

Introduction

A new coronavirus, the severe acute respiratory distress syndrome–coronavirus-2 (SARS-CoV-2/COVID-19), has spread fast throughout the world, leading to high morbidity and mortality.[1] COVID-19 is chiefly a respiratory infection, and the symptoms are related to the age and underlying medical condition of the patient and the immune system.[2] An increasing body of information reported neurological complications of COVID-19, including headache, dizziness, confusion, myalgia, and loss of taste and smell.[3]

Mao et al. assessed neurological symptoms in 214 patients infected with COVID-19, and found that 36.4% of the patients exhibited neurological issues ranging from headache, dizziness, hyposmia, and muscle damage, to ischemic stroke.[4] Guillain–Barré syndrome (GBS) is an autoimmune disease of the peripheral nerves and nerve roots (polyradiculoneuropathy) that is usually caused by various infections such as Campylobacter jejuni, Epstein–Barr virus, influenza, and Zika virus.[5,6] Miller Fisher syndrome (MFS) is a rare subtype of GBS and usually presents with at least two of the following features: ophthalmoplegia, areflexia, and ataxia. Some patients have weakness of the face, tongue, and swallowing muscles, as well as micturition disturbance. Others also develop weakness of the limbs and breathing muscles, and are then considered to have GBS-MFS overlap syndrome.[7,8]

GBS is characterized by ascending flaccid symmetrical limb paralysis with areflexia, sensory symptoms, and often involvement of the cranial nerves. Recently, some cases of GBS were reported in patients infected with COVID-19.[9–11] We have little understanding of how COVID-19 infection results in GBS, and it needs to be investigated further. Although GBS syndrome is rare, the early diagnosis and treatment of GBS can considerably improve outcomes and avoid the need for ventilatory support. Here we report an acute motor sensory axonal neuropathy (AMSAN) case of GBS overlapped with MFS in a patient with COVID-19.

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