Discussion:
Acute inflammatory demyelinating polyradiculoneuropathy or Guillain
Barre syndrome is an immune-mediated nerve disease. Reported causes of
the syndrome are campylobacter, mycoplasma, influenza, Zika virus,
cytomegalovirus, HIV and lymphoma.12Coronavirus (SARS-COV 2) or COVID-19 is a rare cause of Guillain Barre
syndrome.11-13 There are very few cases
worldwide with COVID-19 causing GBS with some of these cases showing a
good response to intravenous
immunoglobulin.14 Other cases showed axonal
neuropathy in the NCS, while others showed demyelinating neuropathy
which is a common type in North America and Europe but thought to be
rare in Africa. Other types of GBS according to the NCS classifications
are acute motor axonal neuropathy (AMAN) and acute sensory motor
neuropathy (ASMAN) which are more frequent in China, Japan and Mexico,
and Miller Fisher syndrome (MFS) which is more common in
Asia.15 In Sudan, we have mixed types of
AIDP, AMAN, ASMAN and MFS.16 In this case,
the patient first presented with weakness ascending in nature involving
the upper limbs, neck and facial muscles on the same day, preceded by a
high-grade fever with rigor and sweating, a dry cough, soreness, and
chest discomfort with normal sensations, sphincter and flexor plantar
responses. The patient came to the Emergency Department at the National
Centre for Neurological Sciences in Khartoum with signs suggestive of
COVID-19 infection-causing GBS. A patient workup was conducted including
general investigations and complete blood counts which showed
lymphopenia, high CRP and serum ferritin levels, normal arterial blood
gases and the presence of a ground-glass appearance which is highly
suggestive of COVID-19 in conjunction with the symptoms. A nasal swab
was taken and sent to the lab. After that, treatment with intravenous
immunoglobulin was started in doses of 28g per day. While the nasal swab
result was pending, the patient showed immediate improvement after IVIG;
the power changed from MRC grade 3 to MRC grade 2. Moreover, the patient
received supportive management for COVID-19 in the form of paracetamol
and vitamins. The patient reported that he was satisfied with the
outstanding response to the treatment. A nerve conduction study showed a
decrease in conduction velocity and delayed latencies with a dispersed
response. This was due to the presence of demyelination, which is
suggestive of the diagnosis of acute inflammatory demyelinating
polyradiculoneuropathy or GBS. A follow-up with the patient after one
month showed complete recovery , the patient walking without support.