Guillain-Barré syndrome in a child with COVID-19 associated multi system inflammatory syndrome

Authors

  • Alekhya Erubothu Department of Paediatrics, Mysore Medical College and Research Institute, Mysore, Karnataka, India
  • Sudha Rudrappa Department of Paediatrics, Mysore Medical College and Research Institute, Mysore, Karnataka, India
  • Pratibha Manjunath Patagar Department of Paediatrics, Mysore Medical College and Research Institute, Mysore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20214166

Keywords:

GBS, Intravenous immunoglobulin, MIS-C, Steroids, Plasmapheresis

Abstract

Multi-system inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 is a new entity affecting a small percentage of children during the COVID-19 pandemic. This usually presents with multi-organ dysfunction, predominantly affecting cardiovascular, muco-cutaneous, and gastrointestinal systems. Till now, neurological manifestations as a part of this spectrum, such as, encephalopathy, inflammatory CNS syndromes, cerebrovascular disease, and Guillain-Barré syndrome (GBS), have been well reported in adults, but there is a paucity of data from the paediatric age group. Here, we present a case of a 6-year-old girl who presented to us with progressive, bilaterally symmetrical ascending weakness of lower limbs followed by upper limbs along with drooling of saliva and dyspnea. Nerve conduction studies showed motor axonal neuropathy suggestive of GBS and child was treated accordingly with intravenous immunoglobulin. On 4th day of admission, the child developed high grade fever spikes, hypotension and diarrhoea. Hence, worked up for MIS-C which revealed elevated inflammatory markers with positive SARS-CoV-19 IgM, IgG antibodies. The diagnosis was hence revised to GBS with MIS-C, the child was then started on methylprednisolone following which the child showed both clinical and biochemical improvement and was then discharged. A high index of suspicion for the possibility of MIS-C should be kept in mind in the present pandemic times, as the immune-mediated damages in MIS-C are potentially treatable with a timely institution of intensive care measures along with the use of steroids, IV-Ig, and plasmapheresis.

References

Mehra B, Aggarwal V, Kumar P, Kundal M, Gupta D, Kumar A et al. COVID-19-associated Severe Multisystem Inflammatory Syndrome in Children with Encephalopathy and Neuropathy in an Adolescent Girl with the Successful Outcome: An Unusual Presentation. Indian J Crit Care Med. 2020;24(12):1276-8.

Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF et al. Multi-system inflammatory syndrome in US children and adolescents. N Engl J Med. 2020;383(4):334-46.

Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A et al. Neurological associations of COVID-19. Lancet Neurol. 2020;19(9):P767-83.

Rahimi K. Guillain-Barre syndrome during COVID-19 pandemic: an overview of the reports. Neurol Sci. 2020;41:3149-56.

Yuki N, Hartung HP. Guillain-Barré syndrome. N Engl J Med. 2012;366(24):2294-304.

Parsons T, Banks S, Bae C, Gelber J, Alahmadi H, Tichauer M. COVID-19-associated acute disseminated encephalomyelitis (ADEM). J Neurol. 2020;(10):1-4.

Curtis M, Bhumbra S, Felker MV. Guillain-Barré syndrome in a child with COVID-19 infection. Pediatrics. 2020;147(4):e2020015115.

Asbury AK. New concepts of Guillain-Barre syndrome. J Child Neurol. 2000;15(3):183-91.

Levison LS, Thomsen RW, Markvardsen LK, Christensen DH, Sindrup SH, Andersen H. Pediatric Guillain-Barre Syndrome in a 30-Year Nationwide Cohort. Pediatr Neurol. 2020;107:57-63.

Dong Y, Mo X, Hu Y. Epidemiology of COVID-19 Among Children in China. Paediatrics. 2020;145:6.

Van den Berg B, Walgaard C, Drenthen J. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. 2014;10:469-82.

Kajumba MM, Kolls BJ, Koltai DC. COVID-19-Associated Guillain-Barre Syndrome: atypical para-infectious profile, symptom overlap, and increased risk of severe neurological complications. SN Compr Clin Med. 2020;2:2702-14.

Downloads

Published

2021-10-25

Issue

Section

Case Reports