Case Presentation: The patient is a 49-year-old male with a history of asymptomatic SARS-CoV-2 infection 3 weeks prior who presented to the emergency department complaining of weakness. It began 1 week ago when he woke up with numbness in his bilateral lower extremities (BLE) accompanied by tingling dysesthesias in the toes. His symptoms rapidly evolved to include facial diparesis, bilateral upper extremity and bulbar weakness with difficulty handling secretions and maintaining an airway. He denied any constitutional symptoms or a history of COVID-19 vaccination. Physical examination revealed an alert and oriented male with a left facial droop and lagophthalmos, decreased strength with areflexia in all of his extremities, and decreased sensation to light touch, vibration and temperature in the hands and BLE. Magnetic resonance imaging (MRI) of the brain was unremarkable but MRI of thoracic and lumbar spine showed diffuse smooth enhancement of the nerve roots. The patient was treated empirically with plasmapheresis and underwent a lumbar puncture which showed an elevated protein level (339mg/dL) with a mildly elevated leukocyte count (13/CUMM). He also underwent an electromyography which showed a predominantly demyelinating pattern. The patient’s condition gradually improved and he was discharged to rehabilitation on hospital day 7.
Discussion: It is widely known that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes acute respiratory disease (coronavirus disease 2019; COVID-19). However, there are increasing reports of neuromuscular manifestations of the viral infection including encephalitis, myositis as well as a small number of cases of Guillain-Barré syndrome (GBS). Here, we present the case of a patient with GBS following a documented history of asymptomatic SARS-CoV-2 infection.
Conclusions: Recent reports suggest that SARS-CoV-2 may have a predilection for neural tissue leading to disorders such as GBS. And unlike typical GBS, most of the reported cases involved the elderly with concomitant COVID-19 pneumonia or acute respiratory distress syndrome resulting in more prevalent demyelinating neuropathy and poorer outcomes. However, the case presented here contradicts the preliminary evidence from many of these cases and case series reported thus far. This suggests that although GBS may manifest in COVID-19 patients, asymptomatic individuals infected with SARS-CoV-2 who are relatively young and healthy may also develop the syndrome. Therefore, practitioners should maintain a high index of suspicion for SARS-CoV-2 infection in patients newly diagnosed with GBS. Furthermore, future studies can determine whether the incidence of GBS is elevated in those with asymptomatic SARS-CoV-2 infection which may help to guide research on novel aspects of this virus to improve future treatment and survival.