Ameer Nasir, Shekhda Kalyan Mansukhbhai, Cheesman Ann
Medicine, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
Medicine, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK.
BMJ Case Rep. 2020 Sep 14;13(9):e236978. doi: 10.1136/bcr-2020-236978.
A construction worker in his 30s presented three times in 4 days with progressive upper and then lower limb weakness. On the first two occasions he had no systemic symptoms, but on the third presentation he had fever and cough, starting from day 4 of weakness. Examination identified weakness in all four limbs and areflexia, suggesting a peripheral neuromuscular disorder. Investigations were consistent with Guillain-Barré syndrome and additional COVID-19 (SARS-CoV-2) infection. The patient improved after immunoglobulin treatment. At least four cases of Guillain-Barré syndrome have been reported in the literature with concurrent COVID-19 illness in whom respiratory signs appeared a few days after the onset of neurological signs. With the incubation period for COVID-19 respiratory symptoms believed to be up to 14 days, it is possible that neurological symptoms could develop before respiratory and other symptoms. During the current pandemic, presence of concurrent COVID-19 infection needs to be considered in patients presenting with Guillain-Barré syndrome.
一名30多岁的建筑工人在4天内3次就诊，先是出现进行性上肢无力，随后出现下肢无力。在前两次就诊时，他没有全身症状，但在第三次就诊时，从无力症状出现的第4天开始，他出现了发热和咳嗽。检查发现四肢均有无力且无反射，提示为周围神经肌肉疾病。检查结果与吉兰 - 巴雷综合征及合并的新型冠状病毒肺炎（SARS-CoV-2）感染相符。患者经免疫球蛋白治疗后病情好转。文献中至少报道了4例吉兰 - 巴雷综合征合并新型冠状病毒肺炎的病例，这些病例中呼吸体征在神经体征出现几天后出现。鉴于新型冠状病毒肺炎呼吸道症状的潜伏期最长可达14天，神经症状有可能在呼吸道及其他症状之前出现。在当前疫情期间，对于出现吉兰 - 巴雷综合征的患者，需要考虑合并新型冠状病毒肺炎感染的情况。
