Lowery Megan M, Taimur Malik Muhammad, Seemiller Joseph, Tsai Cynthia S
Pulmonary/Critical Care Medicine, Geisinger Medical Center, Danville PA, USA.
Geisinger Neuroscience Institute, Geisinger Medical Center, Danville, PA, USA.
J Crit Care Med (Targu Mures). 2020 Nov 7;6(4):231-236. doi: 10.2478/jccm-2020-0038. eCollection 2020 Oct.
A rare variant Miller Fisher Syndrome overlap with Guillain Barre Syndrome is described in an adult patient with SARS-COV-2 infection.
The clinical course of a 45-year-old immunosuppressed man is summarized as a patient who developed ataxia, ophthalmoplegia, and areflexia after upper respiratory infection symptoms began. A nasopharyngeal swab was positive for COVID-19 polymerase chain reaction. He progressed to acute hypoxemic and hypercapnic respiratory failure requiring intubation and rapidly developed tetraparesis. Magnetic resonance imaging of the spine was consistent with Guillain Barre Syndrome. However, the clinical symptoms, along with positive anti-GQ1B antibodies, were consistent with Miller Fisher Syndrome and Guillain Barre Syndrome overlap. The patient required tracheostomy and had limited improvement in his significant neurological symptoms after several months.
The case demonstrates the severe neurological implications, prolonged recovery and implications in the concomitant respiratory failure of COVID-19 patients with neurological symptoms on the spectrum of disorders of Guillain Barre Syndrome.
描述1例感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的成年患者，其患有罕见的变异型米勒-费希尔综合征并伴有吉兰-巴雷综合征。
总结1例45岁免疫抑制男性患者的临床病程，该患者在上呼吸道感染症状出现后，逐渐出现共济失调、眼肌麻痹和腱反射消失。新型冠状病毒肺炎（COVID-19）聚合酶链反应检测显示鼻咽拭子呈阳性。患者进展为急性低氧性和高碳酸血症性呼吸衰竭，需要插管，并迅速发展为四肢轻瘫。脊柱磁共振成像结果符合吉兰-巴雷综合征。然而，临床症状以及抗GQ1B抗体阳性结果符合米勒-费希尔综合征与吉兰-巴雷综合征重叠。患者需要气管切开术，数月后其严重神经症状仅有有限改善。
该病例表明，对于患有吉兰-巴雷综合征谱系障碍且伴有神经症状的COVID-19患者，存在严重的神经影响、恢复时间延长以及并发呼吸衰竭的情况。
