Thiriveedi Mrudula, Sto Domingo Francis G, Longley Sawyer, Patel Siddharth, Baddam Sujatha, Chimakurthy Anil
Department of Internal Medicine, Decatur Morgan Hospital, Decatur, AL, USA.
Department of Medicine, Alabama College of Osteopathic Medicine, Dothan, AL, USA.
Am J Case Rep. 2025 Apr 28;26:e947416. doi: 10.12659/AJCR.947416.
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to the emergence of various neurological complications, including Guillain-Barre syndrome (GBS). GBS is an acute, immune-mediated disorder characterized by progressive weakness, sensory deficits, and autonomic dysfunction. Anti-ganglioside antibodies are often seen in GBS; however, they are rarely reported in the setting of COVID-19-related GBS. We present a case of post-COVID-19 GBS with positive GM1 and GD1b antibodies. CASE REPORT An 86-year-old man presented with progressive quadriparesis, sensory deficits, and hyporeflexia 4 weeks after COVID-19 infection. Brain and spine imaging were unremarkable. Cerebrospinal fluid (CSF) analysis revealed albuminocytological dissociation, consistent with acute inflammatory demyelinating polyneuropathy (AIDP). Despite 2 courses of intravenous immunoglobulin (IVIG), the patient showed minimal improvement in muscle strength. Nerve conduction studies (NCS) revealed severe sensorimotor polyneuropathy, with axonal and demyelinating features. Serum testing showed elevated GM1 and GD1b anti-ganglioside antibody titers. CONCLUSIONS Although numerous cases of COVID-19-related GBS have been reported, anti-ganglioside antibody positivity, particularly GM1 and GD1b, is uncommon. The underlying mechanism is presumed to be autoimmune, likely triggered by molecular mimicry. Our case contributes to the evolving understanding of GBS immunology in the context of COVID-19. Although this case report may not alter current GBS management, the co-occurrence of GM1 and GD1b antibodies in post-COVID-19 GBS underscores the need for continued vigilance, immunological profiling, and research into potential prognostic and therapeutic implications.
背景 由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）大流行已导致各种神经系统并发症的出现，包括吉兰-巴雷综合征（GBS）。GBS是一种急性免疫介导性疾病，其特征为进行性肌无力、感觉障碍和自主神经功能障碍。抗神经节苷脂抗体在GBS中常见；然而，在COVID-19相关GBS病例中鲜有报道。我们报告1例COVID-19后GBS患者，其GM1和GD1b抗体呈阳性。病例报告 一名86岁男性在感染COVID-19后4周出现进行性四肢瘫、感觉障碍和反射减退。脑和脊柱影像学检查无异常。脑脊液（CSF）分析显示蛋白细胞分离，符合急性炎症性脱髓鞘性多发性神经病（AIDP）。尽管接受了2个疗程的静脉注射免疫球蛋白（IVIG）治疗，患者肌力改善甚微。神经传导研究（NCS）显示严重的感觉运动性多发性神经病，具有轴索性和脱髓鞘性特征。血清检测显示GM1和GD1b抗神经节苷脂抗体滴度升高。结论 尽管已报道了大量COVID-19相关GBS病例，但抗神经节苷脂抗体阳性，尤其是GM1和GD1b阳性并不常见。其潜在机制推测为自身免疫性，可能由分子模拟触发。我们的病例有助于在COVID-19背景下不断加深对GBS免疫学的理解。尽管本病例报告可能不会改变当前GBS的治疗方法，但COVID-19后GBS中GM1和GD1b抗体的同时出现强调了持续警惕、免疫谱分析以及对潜在预后和治疗意义进行研究的必要性。
