Guillain-Barré Syndrome Associated with SARS-CoV-2 in Two Pediatric Patients

Abstract

Guillain-Barré syndrome (GBS) is a recognised complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report two children with GBS associated with SARS-CoV-2 who presented to a tertiary centre in Muscat, Oman in 2021: The first patient was a three-month-old female infant who presented with bradypnea, encephalopathy, and generalised weakness that required mechanical ventilation. Polymerase chain reaction (PCR) testing of the nasopharyngeal swabs (NPS) was positive for SARS-CoV-2. She had axonal variant GBS based on a nerve conduction study, cerebrospinal fluid analysis, and neuroimaging findings. The second patient was a six-year-old girl with fever, vomiting, and diarrhea followed by ascending weakness who presented with quadriplegia and facial weakness. Subsequently, she developed respiratory muscle weakness and required mechanical ventilation. PCR testing of NPS was negative for SARS-Cov-2, however IgG serology analysis was positive. The clinical course of these two patients was rapidly progressive and both of them required mechanical ventilation. The patient with axonal variant GBS made an incomplete recovery.

Keywords: Acute Inflammatory Demyelinating Polyradiculoneuropathy; Case Report; Oman; SARS-CoV-2.

Figure 1

A: A gadolinium-enhanced axial T1-weighted image through the posterior fossa showing bilateral enhancement in the internal auditory canals (arrows). B: An axial T2-weighted image of the lumbar spine doesn’t show abnormal thickening of the cauda equina nerve roots. C: Gadolinium-enhanced axial T1-weighted image showing uniform enhancement of the spinal nerve roots. D: The enhancement on the surface of the distal cord and cauda equina nerve roots is also shown on sagittal post-contrast T1 weighted image (arrows).