Khaja Misbahuddin, Gomez Gabriella P Roa, Santana Yaneidy, Hernandez Nolberto, Haider Asim, Lara Jose Luis Perez, Elkin Rene
Division of Pulmonary and Critical Care Medicine, BronxCare Health System Affiliated with the Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.
Department of Medicine, BronxCare Health Center Affiliated with The Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.
Am J Case Rep. 2020 Oct 31;21:e927956. doi: 10.12659/AJCR.927956.
BACKGROUND This case report is of a patient who presented with loss of taste and facial weakness and was diagnosed with Guillain-Barre syndrome (GBS) and Bell's palsy, associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. GBS is a neurological emergency defined as acute inflammatory demyelinating polyneuropathy. The patient responded to intravenous immunoglobulin (IVIG) treatment. CASE REPORT We present the case of a 44-year-old Hispanic man who came for evaluation of bilateral facial weakness and lack of taste sensation. He had lower motor neuron facial weakness. His head computed tomography and brain magnetic resonance imaging scans did not show any pathological abnormalities. He tested positive for SARS-CoV-2 by a nasopharyngeal swab reverse transcription polymerase chain reaction (RT-PCR) test. Cerebrospinal fluid (CSF) analysis via lumbar puncture revealed elevated protein levels, no leukocytes, and a negative Gram stain. The CSF RT-PCR test for SARS-CoV-2 was negative. PCR tests of the CSF for other viral infections were negative. A diagnosis of GBS was made, and he was treated successfully with IVIG. After the fourth dose of IVIG, the patient was able to close his eyes, frown, show his teeth, and smile. CONCLUSIONS Our case is rare because the patient did not present with lower extremity weakness, but only with bilateral Bell's palsy. Physicians should be aware of GBS because it is a neurological emergency for which COVID-19 can be a risk factor. Early diagnosis and treatment of GBS can prevent neurological disability.
背景 本病例报告的患者表现为味觉丧失和面部无力,被诊断为吉兰-巴雷综合征(GBS)和贝尔麻痹,与严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染相关。GBS是一种神经急症,定义为急性炎症性脱髓鞘性多发性神经病。患者对静脉注射免疫球蛋白(IVIG)治疗有反应。病例报告 我们报告一例44岁西班牙裔男性病例,他前来评估双侧面部无力和味觉丧失。他存在下运动神经元性面部无力。他的头部计算机断层扫描和脑磁共振成像扫描未显示任何病理异常。通过鼻咽拭子逆转录聚合酶链反应(RT-PCR)检测,他的SARS-CoV-2呈阳性。通过腰椎穿刺进行的脑脊液(CSF)分析显示蛋白水平升高,无白细胞,革兰氏染色阴性。CSF的SARS-CoV-2 RT-PCR检测为阴性。CSF针对其他病毒感染的PCR检测均为阴性。诊断为GBS,患者接受IVIG治疗成功。在输注第四剂IVIG后,患者能够闭眼、皱眉、露齿和微笑。结论 我们的病例很罕见,因为患者没有出现下肢无力,仅表现为双侧贝尔麻痹。医生应了解GBS,因为它是一种神经急症,而COVID-19可能是其危险因素。GBS的早期诊断和治疗可预防神经功能残疾。