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

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

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

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