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Case Study: Sequential Para-infectious Involvement of Central and Peripheral Nervous System

A patient (52-year-old male) presented with a headache, back pain, vomiting and progressive limb weakness. He had bilateral facial and neck weakness, symmetrical upper and lower limb flaccid (proximal > distal) weakness, generalized areflexia, extensor plantar responses, and preserved sensation. His MRI of the neuroaxis demonstrated gadolinium enhancement of the cervical and lumbar roots and, his CSF was acellular (with an elevated protein level). He was diagnosed with GBS and was treated with IVIG. Three days after admission, his weakness, dysphagia, ophthalmoplegia, and lymphopenia increased. He had type-2 respiratory failure (requiring ventilation) and became febrile. He was treated with antibiotics. A chest CT showed bilateral pulmonary infiltrates and SARS-CoV-2 RNA PCR was positive on a throat swab but negative in CSF. Five days after admission, he became unresponsive and an MRI showed a pattern of T2 symmetrical widespread white matter hyperintensities. He was treated with Intravenous methylprednisolone (IVMP, 1 g/day) for 5 days, improved by the third day of treatment, and continued to improve.

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Updated 2020-08-02

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SARS-CoV-2 (COVID-19)

Biomedical Sciences