Department of Hospital Medicine/Internal Medicine Residency Program, Northeast Georgia Health System Inc, Gainesville, Georgia, USA
Department of Neurology, Northeast Georgia Health System Inc, Gainesville, Georgia, USA.
BMJ Case Rep. 2022 Feb 9;15(2):e246967. doi: 10.1136/bcr-2021-246967.
Neurological manifestations are common in SARS-CoV-2 infection, including life-threatening acute muscle weakness, due to neuromuscular disorders such as acute transverse myelitis (TM) and Guillain-Barré syndrome (GBS). These syndromes can rarely coexist and present as an overlap syndrome. Here, we report a patient who developed acute symmetrical proximal lower limb weakness 5 days after diagnosis of COVID-19. GBS was diagnosed due to the presence of motor signs, albumin-cytological dissociation in cerebrospinal fluid examination and axonal damage according to nerve condition tests. However, abnormal areas on MRI of the thoracic spine and lack of improvement with intravenous immunoglobulin supported a diagnosis of TM. Therefore, a possible overlap between GBS and TM was established. To our knowledge, this is the third case report of GBS/TM overlap syndrome after COVID-19. The patient's full and rapid recovery with intravenous corticosteroids and plasmapheresis supports our diagnosis.
神经系统表现是 SARS-CoV-2 感染的常见表现，包括危及生命的急性肌肉无力，这是由于急性横断性脊髓炎（TM）和吉兰-巴雷综合征（GBS）等神经肌肉疾病引起的。这些综合征很少同时存在，并表现为重叠综合征。在这里，我们报告了 1 例患者，该患者在 COVID-19 诊断后 5 天出现急性对称的近端下肢无力。由于存在运动征象、脑脊液检查中的白蛋白细胞学分离以及神经状况测试显示的轴索损伤，诊断为 GBS。然而，胸段脊柱 MRI 上的异常区域以及静脉注射免疫球蛋白治疗后无改善支持 TM 的诊断。因此，建立了 GBS 和 TM 之间可能存在重叠。据我们所知，这是 COVID-19 后出现的第 3 例 GBS/TM 重叠综合征病例报告。该患者接受静脉注射皮质类固醇和血浆置换后完全和快速恢复，支持我们的诊断。
