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Título

GUILLAIN-BARRE SYNDROME: CASE SERIES

Apresentação do caso

Guillain-Barré Syndrome (GBS) is an acute polyradiculopathy that occurs frequently following infectious diseases, which can lead to an immune response to nerve antigens, resulting in demyelination and/or axonal damage. Below, we will report 4 clinical cases of GBS associated with previous SARS-Cov-2 in pediatric patients. One patient was diagnosed with COVID by PCR testing and three with serology testing. Two patients had previous comorbidities – one had Cantu Syndrome and another had Glycogenosis type Ib. The diagnosis of GBS was confirmed by albuminocitologic dissociation in the cerebrospinal fluid in 3 cases, electroneuromyography with demyelination pattern in all 4 cases, and one patient had brain magnetic resonance imaging showing contrast enhancement in the cauda equina e medullary cone, compatible with inflammatory process. The patients with previous comorbidities evolved with respiratory failure and required mechanical ventilation. 3 patients received intravenous immunoglobulin (IVIg), with adequate response. One of them required two IVIg cycles.

Discussão

The association between GBS and coronaviruses has been previously reported following such infections, including MERS-Cov (KIM et al., 2017) and, more recently, SARS-CoV-2. COVID-19 causes an exaggerated immune response with persistent fever, elevated inflammatory markers and pro-inflammatory cytokines. It is likely an immune dysregulation caused by COVID-19 that increases the risk of immune mediated conditions, such as GBS. It can occur as classic post-infectious disease or as part of the already reported Long COVID-19 Syndrome. The majority of reported cases begin acutely a few days after the viral infection.

Comentários finais

In neurologic presentations compatible with GBS in pediatric patients, we must consider previous or acute SARS-Cov-2 infection as the possible etiology.

Referências (se houver)

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6. RAAHIMI. M,M. ET AL. Late onset of Guillain-Barré syndrome following SARS-CoV-2 infection: part of 'long COVID-19 syndrome'?. BMJ Case Rep. 2021 Jan 18;14(1).

7. KIM, J,E. ET AL. Neurological Complications during Treatment of Middle East Respiratory Syndrome. J Clin Neurol 2017 Jul;13(3):227-233.

8.RMEILEH,S.A. ET AL. Guillain–Barré syndrome spectrum associated with COVID‑19: an up‑to‑date systematic review of 73 cases. Journal of Neurology (2021) 268:1133–1170

Fonte de Fomento (se houver)

Declaração de conflito de interesses de TODOS os autores

The authors declare that they have no conflicts of interest.

Área

Neuroimunologia, esclerose múltipla e outras doenças desmielinizantes