Case Presentation: 37 y/o M with a past medical history of SARS-CoV-2 infection one month prior presented after a syncopal episode and complained of inability to move his lower extremities. On exam he was hypotensive and had 0/5 motor strength in his bilateral lower extremities, decreased rectal tone, and absent patellar reflexes. Sensation to light touch and pin-prick were intact in all extremities. MRI of lumbar spine was negative for disc herniation or nerve root thickening concerning for cauda equina syndrome. He was admitted to intensive care unit (ICU) for hypotension requiring vasopressor support and hypoxic respiratory failure requiring intubation. Lumbar puncture showed albuminocytologic dissociation with increased myelin basic protein, concerning for acute demyelinating inflammatory polyradiculopathy (ADIP), also known as Guillain-Barre syndrome (GBS). Electromyography revealed acute motor axonal neuropathy (AMAN), a purely motor variant of AIDP. Patient received intravenous immunoglobulin therapy and plasmapheresis without improvement in his shock state or paralysis.
Discussion: In the presented case, we detail the clinical course of a patient who was discovered to have a variant of Guillain- Barré Syndrome, acute motor axonal neuropathy (AMAN), precipitated by SARS-CoV-2. This form of acute axonal neuropathy is unique in the fact that it purely affects motor nerve fibers while sparing sensory nerve fibers. Electrodiagnostic studies in patients with AMAN reveal low or absent motor responses with preserved sensory responses. This patient also developed autonomic involvement leading to neurogenic shock, which is particularly rare in this form of GBS. He developed worsening ascending paralysis requiring endotracheal intubation and intermittent bradycardia. While he underwent intravenous immunoglobulin therapy and plasmapheresis (PLEX), he did not recover from his shock state. Patient succumbed to his illness after being removed from life-sustaining measures.
Conclusions: This case report raises a crucial point: the importance of recognizing an acute inflammatory demyelinating polyneuropathy early in its disease course. Neurological and physical recovery strongly depend on early recognition and treatment, as well as interdisciplinary efforts by intensive care and neurology specialists.