治療関連変動を生じた COVID-19 感染後 Guillain-Barré 症候群の 1 例

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  • A case of post COVID-19 Guillain‒Barre syndrome with treatment-related fluctuation
  • 治療関連変動を生じたCOVID-19感染後Guillain-Barre症候群の1例
  • チリョウ カンレン ヘンドウ オ ショウジタ COVID-19 カンセン ゴ Guillain-Barre ショウコウグン ノ 1レイ

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Background: In recent years, reported cases of Guillain-Barre syndrome（GBS）following COVID-19 infection have been accumulating, but their pathogenesis has not been elucidated. Here, we present a rare case of GBS following COVID-19 infection that was accompanied by treatment-related fluctuation（TRF）． Case presentation: A 30-year-old man was referred to our department due to diplopia, numbness in the extremities, and weakness in the right hand and both legs that developed 18 days after COVID-19 infection. A neurological examination revealed left ptosis, mild abduction restriction of the left eye, and horizontal diplopia. Muscle weakness was observed in both the upper and lower limbs, and the deep tendon reflexes of the extremities were absent. The patient also had abnormal sensations in the extremities that had a glove and stocking distribution. Based on the clinical course and the results of his laboratory tests, nerve conduction study and spinal cord MRI findings, we diagnosed him with axonal-type GBS. Later, his anti-GM1 antibody was found to be weakly positive. Although the initial treatment with intravenous immunoglobulin（IVIG）was effective, TRF was thereafter observed. His symptoms did not improve after a second course of IVIG and additional treatments with steroid pulse therapy. However, after the administration of plasma exchange, he recovered gradually, and no further relapse was observed. Conclusion: Although rare, GBS following COVID-19 infection can also be complicated by TRF. Furthermore, post COVID-19 GBS with TRF can presents as axonal type.

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