The diagnosis of COVID Guillain Barre syndrome requires the exclusion of differential diagnoses

Resumen

Dear Editor, We read with interest the article by Cea et al. about three females with SARS-CoV-2 associated Guillain-Barre syndrome (GBS) developing 5 before and 4 and 26 days after onset of COVID-19 respectively a pharyngeal swab PCR positive for SARS-CoV-2 (case 1, case 2, case 3) [1]. Only case 2 required mechanical ventilation. All three patients recovered partially upon application of intravenous immunoglobulins (IVIGs) [1]. The study is appealing but raises concerns that should be discussed. We should be told how the authors knew that respiratory failure in the one patient with a need for mechanical ventilation (case 2) was due to pulmonary compromise from the SARS-CoV-2 infection and not from involvement of the respiratory muscles in GBS. COVID-19 pneumonia not necessarily requires mechanical ventilation in each case. Were there any indications for involvement of the axial or respiratory muscle in GBS in case 2? Because case 2 had involvement of the VIIth, IXth, Xth, and XIIth cranial nerves, Bickerstaff encephalitis (BBE) should be ruled out. An MRI with contrast medium may either show an enhancing lesion in the brainstem or enhancing roots of the lower cranial nerves [2]. Read more...