School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy.
Acute Geriatrics Unit, San Gerardo hospital ASST Monza, Monza, MB, Italy.
BMC Geriatr. 2023 Mar 1;23(1):114. doi: 10.1186/s12877-023-03833-1.
Guillain-Barré syndrome (GBS) is an inflammatory disease of the peripheral nervous system characterized by rapidly evolving polyneuropathy caused by autoimmune demyelination and/or axonal degeneration. Since SARS-CoV-2 outbreak, several GBS cases following exposure to coronavirus disease-2019 (COVID-19) have been reported in literature, raising the concern of the latter being a potential trigger event for GBS.
We report the case of a 90-year-old Caucasian woman who was admitted to our hospital because of fatigue, worsening gait and leg strength, dysphonia, dysarthria and dysphagia, started 3 weeks after being exposed to COVID-19. Based on clinical presentation GBS was suspected, so she performed a lumbar puncture and electromyography, which confirmed the diagnosis of acute motor and sensory axonal neuropathy (AMSAN) variant. We administered high dose of intravenous immunoglobulin with slight neurological improvement. However, after 2 weeks of hospitalization with maximization of care, her physical condition worsen, manifesting severe frailty. The patient was discharged with home support services for managing parenteral nutrition and intense scheduled physiotherapy. A few days later, the patient experienced a further decline in her clinical condition and died at home.
To the best of our knowledge, we report the oldest woman with GBS AMSAN variant after COVID-19 described in the existing literature. Our case supports further research aimed at improving recognition, characterization and prompt management of neurological diseases related to COVID-19 in older patients.
吉兰-巴雷综合征（GBS）是一种周围神经系统的炎症性疾病，其特征为迅速进展的多发性神经病，由自身免疫性脱髓鞘和/或轴突变性引起。自 SARS-CoV-2 爆发以来，文献中报道了几例接触 2019 年冠状病毒病（COVID-19）后发生的 GBS 病例，这引起了人们对后者可能成为 GBS 的潜在触发事件的关注。
我们报告了一例 90 岁白人女性的病例，她因疲劳、步态和腿部力量恶化、发声困难、构音障碍和吞咽困难而入院，这些症状在接触 COVID-19 后 3 周开始出现。根据临床表现怀疑为 GBS，因此进行了腰椎穿刺和肌电图检查，确诊为急性运动和感觉轴索性神经病（AMSAN）变异型。我们给予大剂量静脉免疫球蛋白治疗，略有神经改善。然而，在住院 2 周并进行了最佳护理后，她的身体状况恶化，表现出严重的虚弱。患者出院后接受家庭支持服务，以管理肠外营养和密集的定期物理治疗。几天后，患者的临床状况进一步恶化，在家中去世。
据我们所知，我们报告了现有文献中描述的接触 COVID-19 后年龄最大的 GBS AMSAN 变异型女性病例。我们的病例支持进一步研究，旨在提高对与 COVID-19 相关的老年患者神经疾病的认识、特征描述和及时管理。
