Duong-Quy Sy, Huynh-Truong-Anh Duc, Tran-Xuan Quynh, Nguyen-Quang Tien, Nguyen-Thi-Kim Thanh, Nguyen-Chi Thanh, Tran-Ngoc-Anh Thuy, Nguyen-Van-Hoai Nam, Do-Thi-Thu Mai, Tang-Thi-Thao Tram, Bui-Diem Khue, Hoang-Anh Tien, Nguyen-Ngoc-Phuong Thu, Nguyen-Nhu Vinh
Biomedical Research Center, Lam Dong Medical College, Da Lat, Vietnam.
COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam.
Front Cardiovasc Med. 2023 Jan 19;9:1035896. doi: 10.3389/fcvm.2022.1035896. eCollection 2022.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been an alarming situation worldwide for the past 2 years. The symptoms of coronavirus disease 2019 (COVID-19) are not only confined to the respiratory system but also affect a multitude of organ systems. Bradycardia associated with Guillain-Barré syndrome (GBS) is a rare autonomic and peripheral neurological complication of COVID-19. In this case report, we present the case of a 26-year-old man diagnosed with bradycardia associated with GBS after contracting COVID-19. Initially, this patient had the classical symptoms of COVID-19 and was hospitalized in the intensive care unit (ICU) for acute respiratory distress syndrome (ARDS). Then, he developed weakness in the lower extremities, diminished tendon reflexes, a loss of sensation without sphincter muscle disorders, and bradycardia. His bradycardia did not respond to atropine. The patient was treated concurrently with a high-flow nasal cannula, systemic corticosteroids, anticoagulation, and therapeutic plasma exchange (TPE) for COVID-19-induced ARDS, bradycardia, and GBS. His ARDS and bradycardia improved after the first cycle of TPE and medical treatment. After three cycles of TPE, the patient progressively recovered his muscle strength in the lower limbs and regained peripheral sensation. He was discharged from the hospital in stable condition after 4 weeks of hospitalization and was followed up after 6 months for cardiorespiratory and neurological complications. This case report elucidates the potential difficulties and challenges that physicians may encounter in diagnosing and treating COVID-19-induced bradycardia and GBS during the pandemic outbreak. However, the patient outcomes with the treatment combining the conventional treatment with therapeutic plasma exchange seem to be optimistic.
在过去两年里，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行在全球范围内引发了令人担忧的局面。2019冠状病毒病（COVID-19）的症状不仅局限于呼吸系统，还会影响多个器官系统。与吉兰-巴雷综合征（GBS）相关的心动过缓是COVID-19罕见的自主神经和周围神经并发症。在本病例报告中，我们介绍了一名26岁男性在感染COVID-19后被诊断为与GBS相关的心动过缓的病例。最初，该患者有COVID-19的典型症状，并因急性呼吸窘迫综合征（ARDS）入住重症监护病房（ICU）。随后，他出现下肢无力、腱反射减弱、无括约肌功能障碍的感觉丧失以及心动过缓。他的心动过缓对阿托品无反应。该患者同时接受了高流量鼻导管吸氧、全身用皮质类固醇、抗凝治疗以及针对COVID-19诱发的ARDS、心动过缓和GBS的治疗性血浆置换（TPE）。在第一个TPE周期和药物治疗后，他的ARDS和心动过缓有所改善。经过三个TPE周期后，患者下肢肌肉力量逐渐恢复，外周感觉也得以恢复。住院4周后，他病情稳定出院，并在6个月后接受了心肺和神经并发症的随访。本病例报告阐明了在大流行期间医生在诊断和治疗COVID-19诱发的心动过缓和GBS时可能遇到的潜在困难和挑战。然而，采用传统治疗与治疗性血浆置换相结合的治疗方法，患者的预后似乎较为乐观。
