Concurrent Guillain-Barré syndrome and longitudinally extensive myelopathy secondary to SARS-CoV-2 infection. Case report

Concurrent Guillain-Barré syndrome and longitudinally extensive myelopathy secondary to SARS-CoV-2 infection. Case report

Introduction: Severe acute respiratory syndrome caused by the severe acute res-piratory virus SARS-CoV-2 may have a wide range of neurological manifestations. Guillain-Barré syndrome is a post-infectious acute polyneuropathy characterized by symmetrical and ascending flaccid paralysis, and is described as a complication of SARS-CoV-2 infection and other pathogens. Inflammatory myelopathies associated with the virus have also been described, among which transverse myelitis is the most frequent. Outstanding the autoinflammatory characteristics of both entities, concurrent presentation is possible.

Case description: A 23-year-old male presented with pain and ascending acute weakness syndrome in the lower limbs with impossibility of uri-nation and defecation over a 4-day course. The diagnosis of Guillain Barrè was made by electromyography, and thoracolumbar magnetic resonance imaging was performed, with findings of longitudinally extensive inflammatory myelopathy. An antibody test for SARS-CoV-2 was performed on the cerebrospinal fluid with a positive IgG result, con-sidering neurological compromise due to the virus. Management was performed using plasmapheresis and methylprednisolone pulses, with a favorable response and hospital discharge.

Discussion: The compromise of SARS-CoV-2 in the central and peripheral nervous systems is well known. Pathologies such as Guillain-Barrè syndrome have been widely reported and studied as a consequence of SARS-CoV-2 infection, and a variety of reports of longitudinally extensive inflammatory myelopathy associated with the pathogen have been published; however, the concurrence between both patho-logies has been scarcely reported.

Conclusions: It is necessary to consider a wide variety of atypical and even confluent presentations caused by infectious agents such as SARS-CoV-2 to achieve timely diagnosis and management that reduces morbidity and mortality in patients.