Two clinical cases of Guillain-Barre syndrome after COVID-19 infection

Background and Aims: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is causing the pandemic of COVID-19. Patients with COVID-19 typically present with fever, respiratory illness;other symptoms are also described. The neurological signs of SARS-CoV-2 remain poorly understood. There is recognition of a link between COVID-19 and Guillain-Barre syndrome (GBS). We report two male patients, 46-years-old and 53-years old, that were admitted with acute progressive symmetric ascending quadraparesis, starting in the legs 4 days prior. At admittance both were unable to stand on their feet, with lack of deep tendon reflexes in the lower extremities, tingling sensation and distal weakness in their arms, no bulbar symptoms or incontinence. 7-10 days before the hospitalization, they were treated for COVID-19-pneumonia with full recovery. Both were proven to be PCR negative for SARS-CoV-2 on admittance. Methods: Medical history, radiology, lab results, EMG and lumbar puncture. Results: Chest X-ray, CT-and MRI-scan of the brain were performed with no abnormalities, as were the serology and microbiology analyses. Cerebrospinal fluid analysis returned elevated protein levels (1,81g/l and 1.12g/l respectively). Electromyography findings showed acute motorsensory axonal neuropathy, so the diagnosis of GBS was established. Both were treated with three plasmapheresis procedures, showing established improvement of the symptoms. Conclusions: The SARS-CoVID-2 associated GBS cases are rare. The most common COVID-19-symptoms are respiratory infections and twothirds of GBS patients mention respiratory infections before the onset of symptoms, hence GBS should be considered as neurological complications of COVID-19 and as such, when indicated, plasmapheresis should be initiated along with antiviral treatment.