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More Evidence Supports COVID-19 / Gilan-Valley Link


Editor’s Note: Search for the latest Medscape COVID-19 news and guidance Coronavirus Resource Center.

5 more cases Giran Barre A COVID-19-related syndrome (GBS) has been identified, further supporting the association of the virus with nervous system complications including GBS.

This account by an Italian researcher First reported case COVID-19 displayed as GBS.

The article was written with first authors Gianpaolo Toscano, MD, IRCCS C. Mondino Foundation, Pavia, Italy, Published online April 17 New England Medical Journal

Five GBS cases occurred in three Italian hospitals from February 28th to March 21st. During this period, there were an estimated 1000-1200 COVID-19 hospitalizations.

The onset of GBS in 5 patients occurred 5-10 days after the initial COVID-19 diagnosis.

Three patients developed demyelinating GBS. The other two had similar findings with axonal variants. All five patients received intravenous immunoglobulin therapy.

After four weeks of treatment, two patients were on a ventilator in the intensive care unit and the other two were on physical therapy because of flaccid paraplegia and minimal upper limb movement. The fifth patient was discharged and walked independently.

Although apparently rare, these additional cases help raise awareness of GBS as a potential complication of COVID-19 among frontline clinicians.

Given the small number of cases in this observation series, it is unclear whether severe neuropathy and axonal involvement are typical features of COVID-19-related GBS.

Furthermore, it was not possible to determine whether the respiratory problems associated with COVID-19 were unrelated to the GBS weakness.

However, the authors note that such effects “may be considered if the chest image findings are disproportionate to the severity of respiratory failure.”

“Guillain-Barre syndrome with Covid-19 should be distinguished from severe neuropathy and myopathy, which tend to appear after a more severe course than Guillain-Barre syndrome,” the authors write.

Toscano does not disclose the financial relationship involved.

New Engl J Med. Published online April 17, 2020. Full text

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