Boostani Reza, Talab Fariborz Rezai, Meibodi Naser Tayyebi, Zemorshidi Fariba
Department of Neurology, Mashhad university of medical science, Mashhad, Iran.
Cutaneous Leishmaniasis Research Center, Mashhad university of medical science, Mashhad, Iran.
J Neuroimmunol. 2020 Nov 7;350:577434. doi: 10.1016/j.jneuroim.2020.577434.
A novel betacoronavirus,SARS-CoV-2, causes Coronavirus disease 2019 typically presented with fever, myalgia and cough, but central and peripheral nervous system manifestations such as stroke, encephalitis and Guillain-Barre-Syndrome are being increasingly reported. Acute immune-mediated polyradiculoneuropathy (Guillain-Barre-Syndrome) mostly occurs after viral or bacterial infections, presenting with ascending flaccid tetraparesis, dysautonomia and respiratory failure. We reported a patient with COVID-19 (confirmed with Lung HRCT scan and positive SARS-CoV-2 PCR) who developed acute progressive flaccid tetraparesis and maculopapular pigmented plaques on the limbs, 2 weeks after respiratory symptoms. He was treated with IVIg as the Electrophysiologic study showed sensorimotor polyradiculoneuropathy with demyelinating features and skin biopsy showed interface dermatitis and vasculopathic reaction. The causal association between Guillen-Barre-Syndrome and COVID-19 is uncertain yet, but neurologists should be aware of early diagnosis and treatment of acute polyradiculoneuropathy which may cause fatal dysautonomia and respiratory failure in the context of COVID19 pandemic.
一种新型β冠状病毒,即严重急性呼吸综合征冠状病毒2型(SARS-CoV-2),引发了2019冠状病毒病,其典型症状为发热、肌痛和咳嗽,但中枢神经系统和周围神经系统表现,如中风、脑炎和吉兰-巴雷综合征等,报告也越来越多。急性免疫介导性多发性神经根神经病(吉兰-巴雷综合征)大多发生在病毒或细菌感染后,表现为进行性上升性弛缓性四肢瘫、自主神经功能障碍和呼吸衰竭。我们报告了1例2019冠状病毒病患者(经肺部高分辨率CT扫描确诊且严重急性呼吸综合征冠状病毒2型聚合酶链反应呈阳性),该患者在出现呼吸道症状2周后出现急性进行性弛缓性四肢瘫和四肢斑丘疹色素沉着斑。因其电生理研究显示感觉运动性多发性神经根神经病伴脱髓鞘特征,皮肤活检显示界面性皮炎和血管病变反应,故给予静脉注射免疫球蛋白治疗。吉兰-巴雷综合征与2019冠状病毒病之间的因果关系尚不确定,但在2019冠状病毒病大流行背景下,神经科医生应注意急性多发性神经根神经病的早期诊断和治疗,因为该病可能导致致命的自主神经功能障碍和呼吸衰竭。