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LETTERS TO THE EDITOR
Year : 2021  |  Volume : 24  |  Issue : 5  |  Page : 793-794
 

The youngest pediatric guillain barre syndrome associated with COVID-19 infection


Department of Pediatrics, K.E.M. Hospital and research Centre, Pune, Maharashtra, India

Date of Submission19-Jan-2021
Date of Acceptance03-Mar-2021
Date of Web Publication03-Jan-2021

Correspondence Address:
Dr. Abhijeet Botre
Department of Pediatrics, K.E.M. Hospital and Research Centre, Moodliyar Road, Rasta Peth, Pune - 411 011, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.AIAN_52_21

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How to cite this article:
Botre A, Mishra A, Kadam S. The youngest pediatric guillain barre syndrome associated with COVID-19 infection. Ann Indian Acad Neurol 2021;24:793-4

How to cite this URL:
Botre A, Mishra A, Kadam S. The youngest pediatric guillain barre syndrome associated with COVID-19 infection. Ann Indian Acad Neurol [serial online] 2021 [cited 2022 Jul 5];24:793-4. Available from: https://www.annalsofian.org/text.asp?2021/24/5/793/317473




Sir,

COVID-19 pandemic has been ravaging the entire world over the past 14 months. Patients present with various symptoms ranging from acute infective pulmonary involvement to immune-related multi-organ failure (multi-systemic Inflammatory syndrome in children [MIS-C]). In the last 6 months, sporadic cases of GBS with COVID-19 have been reported, but, only in adults.[1],[2],[3],[4],[5] Children are rarely affected (<2% of all patients), and usually have mild symptoms. GBS, which is characterized by flaccid ascending flaccid paralysis with/without sensory involvement, has been reported in adult patients with COVID-19.

We report a 3.5-year-old boy who presented with mild-to-moderate fever and centrifugally distributed maculo-papular rash over the body, which faded without scaring in 4 days. On evaluation, he was found to be positive for SARS-CoV-2 by RT-PCR. He got infected from his parents (paramedical staff working in a dedicated COVID-19 facility). He was being treated with IVIG and steroids for the management of MIS-C. He had fever, rash, tachycardia on examination with coronary dilation on 2D ECHO and raised inflammatory markers (ESR 48 mm/h, LDH 829 U/L, CRP 48.3 mg/L, D-Dimer 2058 ng/mL ). On the seventh day of illness, he became drowsy and was unable to swallow. Over the next 24 h, he developed rapidly progressive ascending paralysis (power of the lower limb was 0/5 and the upper limb was 1/5 with areflexia) bilateral facial weakness, right ptosis and external ophthalmoplegia with absent gag and dysautonomia (tachycardia and hypertension). He was alert, but needed intubation and mechanical ventilation. His CPK and potassium levels were normal, as was the CSF analysis (protein 38 mg%, sugar 55 mg%, and two lymphocytes). The MRI was [Figure 1] suggestive of spinal root enhancement and thickening with normal brain structures. Nerve conduction studies had features of early GBS (absent F waves and low CMAP amplitude in bilateral peroneal nerves other nerves showed normal latencies amplitude and conduction velocities). The anti-ganglioside antibodies were negative. A clinical diagnosis of GBS was made. He was extubated successfully with improving gag within 48–96 h. His power in all four limbs started improving by 5 days. On day 7 of the presentation, his upper limb power was >4/5 and lower limb power was 2/5. At follow-up (4 weeks), he was walking independently and had significant improvement in extraocular eye movements with supportive treatment as intravenous immunoglobulin (IvIgG) was already given with intravenous methylprednisolone.
Figure 1: MRI spine showing abnormal thickening and enhancement of spinal nerve roots

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Children account for only 2.1% of all COVID-19 cases.[6] Children <10 years of age account for 1% of total cases.[7] MIS-C mimicking Kawasaki disease has been reported from various centers worldwide. GBS, an autoimmune disease with progressive areflexic paralysis and mild sensory involvement, has been reported in adult patients with COVID-19. The mechanism of GBS related to COVID-19 has not been delineated yet.[3] Probable mechanisms suggested are as follows: (a) post-infectious syndrome, (b) molecular mimicry between viral protein-associated ganglioside and peripheral nerve ganglioside, (c) nerve damage by T cell activation, (d) release of inflammatory mediators by macrophage, and (e) para-infectious mechanism for GBS by hyperinflammatory response to COVID-19 has been suggested.

This child developed GBS within a week of testing positive for COVID-19.

GBS in children progresses rapidly, but recovery is fast if diagnosed and treated timely.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Scheidl E, Canseco DD, Hadji-Naumov A, Bereznai B. Guillain-Barré syndrome during SARS-CoV-2 pandemic: A case report and review of recent literature. J Peripher Nerv Syst 2020;25:204-7.  Back to cited text no. 1
    
2.
James BC, Ryan J, Castoro RJ, Simmons Z, Lewis RA, Ahlawat A, et al. COVID-19-associated Guillain-Barré syndrome: The early pandemic experience. Muscle Nerve 2020;62:485-91.  Back to cited text no. 2
    
3.
Webb S, Wallace VC, Martin-Lopez D, Yogarajah M. Guillain-Barré syndrome following COVID-19: A newly emerging post-infectious complication. BMJ Case Rep 2020;13:e236182.  Back to cited text no. 3
    
4.
Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. Guillain-Barré syndrome associated with SARS-CoV-2. N Engl J Med 2020;382:2574-6.  Back to cited text no. 4
    
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Carrillo-Larco RM, Altez-Fernandez C, Ravaglia S, Vizcarra JA. COVID19 and Guillain-Barre syndrome: A systematic review of case reports. Wellcome Open Res 2020;5:107.  Back to cited text no. 5
    
6.
Zare-Zardini H, Soltaninejad H, Ferdosian F, Hamidieh AA, Memarpoor-Yazdi M. Coronavirus disease 2019 (COVID-19) in children: Prevalence, diagnosis, clinical symptoms, and treatment. Int J Gen Med 2020;13:477-82.  Back to cited text no. 6
    
7.
Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020;109:1088-95.  Back to cited text no. 7
    


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