scholarly journals Guillain-Barre syndrome related to COVID-19: muscle and nerve biopsy findings

2021 ◽  
Vol 31 (3) ◽  
pp. 465-469
Author(s):  
Dandara Costa Lima de Souza ◽  
Rafael Basílio Guimarães ◽  
Alzira De Siqueira Carvalho
Keyword(s):  
Peripheral Nerve ◽  
Nerve Biopsy ◽  
Neurological Complications ◽  
Guillain Barre Syndrome ◽  
Morphological Aspects ◽  
Guillain Barré Syndrome ◽  
Respiratory Discomfort ◽  
Guillain Barré ◽  
Inflammatory Infiltrates ◽  
Muscle Biopsies

Background: The involvement of the peripheral nervous system (PNS) in COVID-19 is rare and, to date, morphological aspects from muscle and nerve biopsies have not been reported. Here, we describe a case of Guillain-Barré Syndrome (GBS) related to COVID-19 and demonstrate findings from peripheral nerve and skeletal muscle biopsies. A 79-year-old man presented with progressive weakness in both legs over one-week, evolving to both arms and urinary retention within 6 days. Four days earlier, he had a cough, febrile sensation and mild respiratory discomfort. On admission, his was afebrile, and without respiratory distress. A neurological examination disclosed asymmetric proximal weakness, diminished reflexes and no sensitive abnormalities. Three days later, the patient presented with bilateral facial weakness and proximal muscle strength worsened. Deep tendon reflexes and plantar responses were absent. Both superficial and profound sensitivity were decreased. From this point, oxygen saturation worsened, and the patient was placed on mechanical ventilation. CSF testing revealed one cell and protein 185 mg/dl. A chest CT showed the presence of ground-glass opacities and RT-PCR for SARS-CoV-2 was positive. The muscle biopsy revealed moderate neuromyopathic findings with positive expression for MHC-class I, C5b9, CD8 and CD68. The nerve biopsy showed inflammatory infiltrates predominantly with endoneurial compound formed by CD45 and CD68. The patient was treated with Oseltamivir for 9 days followed by IVIG for 5 days and died three days later of septic shock. Discussion: This is the first documented case of GBS associated with COVID-19 with a muscle and nerve anatomopathological study. A systematic review about neurological complications caused by COVID-19 described 11 patients with GBS. The morphological features reported in our patient showed signs of involvement of the immune system, suggesting that direct viral invasion could have played a role in the pathogenesis of peripheral nerve injury. Hereafter, further research will be necessary to understand the triggers for these cells migrating into the peripheral nerve.

scholarly journals Bilateral upper limb neuropathies following prone ventilation for COVID-19 pneumonia

2020 ◽  
pp. 10.1212/CPJ.0000000000000944
Author(s):  
William K Diprose ◽  
Laura Bainbridge ◽  
Richard W Frith ◽  
Neil E Anderson
Keyword(s):  
Peripheral Nerve ◽  
Upper Limb ◽  
Neurological Complications ◽  
Guillain Barre Syndrome ◽  
Link Type ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

The neurological complications of COVID-19 and its treatment are still being elucidated.1,2 Guillain-Barré Syndrome has been reported in COVID-19 patients, but other peripheral nerve complications have not been described. We report a case of bilateral upper limb neuropathies in a patient with COVID-19 pneumonia managed with prolonged prone ventilation.

scholarly journals Rare variant of Guillain-Barré syndrome after chikungunya viral fever

2019 ◽  
Vol 12 (4) ◽  
pp. e228845 ◽  
Author(s):  
Sajid Hameed ◽  
Sara Khan
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
Symptom Onset ◽  
Complete Resolution ◽  
Neurological Complications ◽  
Acute Onset ◽  
Guillain Barre Syndrome ◽  
Ventilator Support ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Chikungunya (CHIK) viral fever is a self-limiting illness that presents with severe debilitating arthralgia, myalgia, fever and rash. Neurological complications are rare. We present a case of a 36-year-old woman who presented with acute onset progressive difficulty swallowing and left arm weakness. She was diagnosed with CHIK viral fever 4 weeks prior to admission. After investigations, she was diagnosed with a pharyngeal–cervical–brachial variant of Guillain-Barré syndrome. In hospital, she required ventilator support. Her condition improved after five sessions of intravenous immunoglobulin with almost complete resolution within 6 months of symptom onset. With frequent CHIK outbreaks, the neurological complications are increasingly seen in the emergency department. The knowledge of these associations will result in early diagnosis and treatment.

scholarly journals Acute neuromuscular weakness associated with dengue infection

2012 ◽  
Vol 03 (01) ◽  
pp. 36-39 ◽  
Author(s):  
Harmanjit Singh Hira ◽  
Amandeep Kaur ◽  
Anuj Shukla
Keyword(s):  
Dengue Virus ◽  
Dengue Infection ◽  
Neurological Complications ◽  
Electrolyte Imbalance ◽  
Guillain Barre Syndrome ◽  
Motor Weakness ◽  
Presenting Symptoms ◽  
Guillain Barré Syndrome ◽  
Serotype 1 ◽  
Guillain Barré

ABSTRACT Background: Dengue infections may present with neurological complications. Whether these are due to neuromuscular disease or electrolyte imbalance is unclear. Materials and Methods: Eighty-eight patients of dengue fever required hospitalization during epidemic in year 2010. Twelve of them presented with acute neuromuscular weakness. We enrolled them for study. Diagnosis of dengue infection based on clinical profile of patients, positive serum IgM ELISA, NS1 antigen, and sero-typing. Complete hemogram, kidney and liver functions, serum electrolytes, and creatine phosphokinase (CPK) were tested. In addition, two patients underwent nerve conduction velocity (NCV) test and electromyography. Results: Twelve patients were included in the present study. Their age was between 18 and 34 years. Fever, myalgia, and motor weakness of limbs were most common presenting symptoms. Motor weakness developed on 2 nd to 4 th day of illness in 11 of 12 patients. In one patient, it developed on 10 th day of illness. Ten of 12 showed hypokalemia. One was of Guillain-Barré syndrome and other suffered from myositis; they underwent NCV and electromyography. Serum CPK and SGOT raised in 8 out of 12 patients. CPK of patient of myositis was 5098 IU. All of 12 patients had thrombocytopenia. WBC was in normal range. Dengue virus was isolated in three patients, and it was of serotype 1. CSF was normal in all. Within 24 hours, those with hypokalemia recovered by potassium correction. Conclusions: It was concluded that the dengue virus infection led to acute neuromuscular weakness because of hypokalemia, myositis, and Guillain-Barré syndrome. It was suggested to look for presence of hypokalemia in such patients.

scholarly journals IgD Multiple Myeloma Paraproteinemia as a Cause of Myositis

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
I. Colombo ◽  
M. E. Fruguglietti ◽  
L. Napoli ◽  
M. Sciacco ◽  
E. Tagliaferri ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Peripheral Nerve ◽  
Muscle Biopsy ◽  
Nerve Biopsy ◽  
Marrow Transplant ◽  
Sural Nerve Biopsy ◽  
Direct Immunofluorescence ◽  
Inflammatory Pattern ◽  
Inflammatory Infiltrates ◽  
Muscle Biopsies

A 48-years old man was diagnosed an IgD-k multiple myeloma (MM) at age 38 years for which he successfully underwent chemotherapy and bone marrow transplant. He then developed a graft-versus-host disease (GVHD) whose manifestations included, three years later, a polymyositis, diagnosed at muscle biopsy and successfully treated with steroids. Few months after polymyositis remission, myeloma relapsed and the patient was treated with thalidomide for six years with good remission. Soon after thalidomide suspension, MM relapsed again and the patient came to our observation for a new onset of neuromuscular symptoms. He underwent both muscle and peripheral nerve biopsy to discriminate between myositis (paraproteinemia versus GVHD), amyloidosis, and thalidomide toxicity. The first muscle biopsy showed an inflammatory pattern with necrotic fibres, macrophagical invasion (CD68 positive), rare interstitial cellular infiltrates (CD8 positive and CD4 negative), widespread anti-HLA positivity and negative antiMAC. The second muscle biopsy showed the same inflammatory pattern plus an involvement of blood vessels. Direct immunofluorescence for IgD showed diffuse positivity along the sarcolemmal in both muscle biopsies. Sural nerve biopsy demonstrated both demyelinating and axonal aspects with no inflammatory infiltrates, but positivity for HLA and MAC. Congo Red was negative in both skeletal muscle and peripheral nerve.

Motor nerve biopsy in severe Guillain-Barré syndrome

1992 ◽  
Vol 31 (4) ◽  
pp. 441-444 ◽  
Author(s):  
Susan M. Hall ◽  
Richard A. C. Hughes ◽  
Penny F. Atkinson ◽  
Ian McColl ◽  
Andrew Gale
Keyword(s):  
Motor Nerve ◽  
Nerve Biopsy ◽  
Guillain Barre Syndrome ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Serial peripheral nerve ultrasound in Guillain–Barré syndrome

2016 ◽  
Vol 127 (2) ◽  
pp. 1652-1656 ◽  
Author(s):  
Siti Nur Omaira Razali ◽  
Thaarani Arumugam ◽  
Nobuhiro Yuki ◽  
Faizatul Izza Rozalli ◽  
Khean-Jin Goh ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Guillain Barre Syndrome ◽  
Nerve Ultrasound ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

scholarly journals Guillain-Barré syndrome following Zika virus infection is associated with a diverse spectrum of peripheral nerve reactive antibodies

2021 ◽  
Author(s):  
Alexander J Davies ◽  
Cinta Lleixà ◽  
Ana M Siles ◽  
Dawn Gourlay ◽  
Georgina Berridge ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Zika Virus ◽  
Target Identification ◽  
Guillain Barre Syndrome ◽  
Igg Antibody ◽  
Humoral Immune ◽  
Cellular Models ◽  
Inflammatory Neuropathy ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Introduction Recent outbreaks of Zika virus (ZIKV) in South and Central America have highlighted significant neurological side effects. Concurrence with the inflammatory neuropathy Guillain-Barré syndrome (GBS) is observed in 1:4000 ZIKV cases. Whether the neurological symptoms of ZIKV infection are a consequence of autoimmunity or direct neurotoxicity is unclear. Methods We employed rat dorsal root ganglion (DRG) neurons, Schwann cells (SCs), and human stem cell-derived sensory neurons myelinated with rat SCs as cellular models to screen for anti-peripheral nerve reactive IgG and IgM autoantibodies in sera of ZIKV patients with and without GBS. In this study, 52 ZIKV-GBS patients were compared with 134 ZIKV-infected patients, and 91 non-ZIKV controls. Positive sera were taken forward for target identification by immunoprecipitation and mass spectrometry, and candidate antigens validated by ELISA and cell-based assays. Autoantibody reactions against glycolipid antigens were also screened on an array. Results Overall, IgG antibody reactivity to rat SCs (6.5%) and myelinated co-cultures (9.6%) were significantly higher, albeit infrequently, in the ZIKV-GBS group compared to all controls. IgM antibody immunoreactivity to DRGs (32.3%) and SCs (19.4%) was more frequently observed in the ZIKV-GBS group compared to other controls, while IgM reactivity to co-cultures was as common in ZIKV and non-ZIKV sera. Strong axonal-binding ZIKV-GBS serum IgG antibodies from one patient were confirmed to react with neurofascin-155 and 186. Serum from a ZIKV non-GBS patient displayed strong myelin-binding and anti-lipid antigen reaction characteristics. There was however no significant association of ZIKV-GBS with any anti-glycolipid antibodies. Conclusion Autoantibodies in ZIKV associated GBS patient sera target heterogeneous peripheral nerve antigens suggesting heterogeneity of the humoral immune response despite a common prodromal infection.

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