Isolated facial diplegia as an atypical variant of Guillain-Barre syndrome after suspected SARS-CoV-2 infection
Introduction: Since the SARS-CoV-2 pandemics began, multiple cases of Guillain-Barre syndrome secondary to COVID-19 have been described. Its typical presentation consists of the triad of paresthesia, ascending muscle weakness and areflexia, although there are several regional variants such as facial...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2021
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/32392 |
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I10-R327-article-32392 |
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Universidad Nacional de Córdoba |
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R-327 |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
| format |
Artículo revista |
| topic |
guillain-barre syndrome coronavirus infections facial paralysis betacoronavirus síndrome de guillain-barré infecciones por coronavirus parálisis facial betacoronavirus síndrome de guillain-barré infecções por coronavirus paralisia facial betacoronavirus |
| spellingShingle |
guillain-barre syndrome coronavirus infections facial paralysis betacoronavirus síndrome de guillain-barré infecciones por coronavirus parálisis facial betacoronavirus síndrome de guillain-barré infecções por coronavirus paralisia facial betacoronavirus Lavilla Olleros, Cristina López-Rubio, Marina Fanciulli, Chiara González-Munera, Adriana Millán Núñez-Cortés, Jesús Isolated facial diplegia as an atypical variant of Guillain-Barre syndrome after suspected SARS-CoV-2 infection |
| topic_facet |
guillain-barre syndrome coronavirus infections facial paralysis betacoronavirus síndrome de guillain-barré infecciones por coronavirus parálisis facial betacoronavirus síndrome de guillain-barré infecções por coronavirus paralisia facial betacoronavirus |
| author |
Lavilla Olleros, Cristina López-Rubio, Marina Fanciulli, Chiara González-Munera, Adriana Millán Núñez-Cortés, Jesús |
| author_facet |
Lavilla Olleros, Cristina López-Rubio, Marina Fanciulli, Chiara González-Munera, Adriana Millán Núñez-Cortés, Jesús |
| author_sort |
Lavilla Olleros, Cristina |
| title |
Isolated facial diplegia as an atypical variant of Guillain-Barre syndrome after suspected SARS-CoV-2 infection |
| title_short |
Isolated facial diplegia as an atypical variant of Guillain-Barre syndrome after suspected SARS-CoV-2 infection |
| title_full |
Isolated facial diplegia as an atypical variant of Guillain-Barre syndrome after suspected SARS-CoV-2 infection |
| title_fullStr |
Isolated facial diplegia as an atypical variant of Guillain-Barre syndrome after suspected SARS-CoV-2 infection |
| title_full_unstemmed |
Isolated facial diplegia as an atypical variant of Guillain-Barre syndrome after suspected SARS-CoV-2 infection |
| title_sort |
isolated facial diplegia as an atypical variant of guillain-barre syndrome after suspected sars-cov-2 infection |
| description |
Introduction: Since the SARS-CoV-2 pandemics began, multiple cases of Guillain-Barre syndrome secondary to COVID-19 have been described. Its typical presentation consists of the triad of paresthesia, ascending muscle weakness and areflexia, although there are several regional variants such as facial diplegia.
Case presentation: Two weeks after a contact with a confirmed case of COVID-19, a 35-year-old woman presents with viral myopericarditis. Laboratory studies for autoimmune diseases come back negative, as well as multiple viral serologies. She presents anti-SARS-CoV-2 IgG, with negative PCR. A week after discharge she presents with palsy of both facial nerves, without other neurological abnormalities. She undergoes examination with cranial CT without findings, and an EMG which shows bilateral alteration of facial nerves. She refuses the performance of a lumbar puncture.
Discussion: Facial diplegia can occur because of several illnesses, such as meningeal or brainstem tumors, infectious agents, Guillain-Barre syndrome, autoimmune diseases, trauma, metabolic causes or congenital causes. In our patient, having discarded other etiologies with imaging and analytical studies, the most probable cause is the Guillain-Barre syndrome. It is possibly secondary to SARS-CoV-2 infection given the presence of anti-SARS-CoV-2 IgG antibodies after contact with a confirmed case.
Conclusion: This case supports the hypothesis that COVID-19 may trigger the Guillain-Barre syndrome, specifically as facial diplegia, which is an atypical variant that should be known to be early diagnosed and treated as part of this syndrome. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2021 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/32392 |
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I10-R327-article-323922021-12-29T20:14:46Z Isolated facial diplegia as an atypical variant of Guillain-Barre syndrome after suspected SARS-CoV-2 infection Diplejía facial aislada como variante atípica del síndrome de Guillain-Barré tras sospecha de infección por SARS-CoV-2 Diplegia facial isolada como uma variante atípica da síndrome de Guillain-Barré após suspeita de infecção por SARS-CoV-2 Lavilla Olleros, Cristina López-Rubio, Marina Fanciulli, Chiara González-Munera, Adriana Millán Núñez-Cortés, Jesús guillain-barre syndrome coronavirus infections facial paralysis betacoronavirus síndrome de guillain-barré infecciones por coronavirus parálisis facial betacoronavirus síndrome de guillain-barré infecções por coronavirus paralisia facial betacoronavirus Introduction: Since the SARS-CoV-2 pandemics began, multiple cases of Guillain-Barre syndrome secondary to COVID-19 have been described. Its typical presentation consists of the triad of paresthesia, ascending muscle weakness and areflexia, although there are several regional variants such as facial diplegia. Case presentation: Two weeks after a contact with a confirmed case of COVID-19, a 35-year-old woman presents with viral myopericarditis. Laboratory studies for autoimmune diseases come back negative, as well as multiple viral serologies. She presents anti-SARS-CoV-2 IgG, with negative PCR. A week after discharge she presents with palsy of both facial nerves, without other neurological abnormalities. She undergoes examination with cranial CT without findings, and an EMG which shows bilateral alteration of facial nerves. She refuses the performance of a lumbar puncture. Discussion: Facial diplegia can occur because of several illnesses, such as meningeal or brainstem tumors, infectious agents, Guillain-Barre syndrome, autoimmune diseases, trauma, metabolic causes or congenital causes. In our patient, having discarded other etiologies with imaging and analytical studies, the most probable cause is the Guillain-Barre syndrome. It is possibly secondary to SARS-CoV-2 infection given the presence of anti-SARS-CoV-2 IgG antibodies after contact with a confirmed case. Conclusion: This case supports the hypothesis that COVID-19 may trigger the Guillain-Barre syndrome, specifically as facial diplegia, which is an atypical variant that should be known to be early diagnosed and treated as part of this syndrome. Introducción: Desde que se inició la pandemia por el SARS-CoV-2, se han descrito numerosos casos de síndrome de Guillain-Barré secundario a la COVID-19. Su presentación típica es la triada de parestesias, debilidad muscular ascendente y arreflexia, aunque hay diversas variantes regionales como la diplejía facial. Presentación del caso: Mujer de 35 años que, dos semanas después de un contacto estrecho con un caso confirmado de COVID-19, ingresa por miopericarditis probablemente viral, con estudio de autoinmunidad negativo, múltiples serologías virales negativas y positividad para IgG anti-SARS-CoV-2 con PCR negativa. Una semana tras el alta presenta paresia de ambos nervios faciales sin otras alteraciones neurológicas. Se realiza TAC craneal sin hallazgos y EMG que evidencia afectación bilateral de los nervios faciales. La paciente rechaza realización de punción lumbar Discusión: La diplejía facial puede ocurrir en el contexto de diversas patologías, como tumores meníngeos o troncoencefálicos, agentes infecciosos, síndrome de Guillain-Barré, patologías autoinmunes, traumatismos, causas metabólicas o causas congénitas. En el caso descrito tras descartar mediante pruebas de imagen y analíticamente el resto de etiologías, y dada la presentación clínica, permanece como causa más probable el síndrome de Guillain-Barré, posiblemente secundario a infección por SARS-CoV-2 dada la positividad de IgG anti-SARS-CoV-2 tras un contacto con un caso confirmado. Conclusión: Este caso apoya la hipótesis de que la COVID-19 puede desencadenar el síndrome de Guillain-Barré, específicamente en forma de diplejía facial, una variante atípica que se debe conocer para su identificación y manejo precoz como parte de este síndrome. Introdução: Desde o início da pandemia SARS-CoV-2, numerosos casos de síndrome de Guillain-Barré secundária ao COVID-19 foram relatados. Sua apresentação típica é a tríade de parestesia, fraqueza muscular ascendente e arreflexia, embora existam muitas variantes regionais, como a diplegia facial. Relato do caso: Mulher de 35 anos que, duas semanas após contato com um caso confirmado de COVID-19, é internada devido a miopericardite de provável etiologia viral, com um estudo de autoimunidade negativo, múltiplas sorologias virais negativas e IgG positiva para SARS-CoV-2 com PCR negativo. Uma semana após a alta, apresentou paresia de ambos os nervos faciais sem outras alterações neurológicas. Uma tomografia computadorizada de crânio foi realizada sem achados e um EMG mostrando envolvimento bilateral dos nervos faciais. O paciente se recusa a realizar uma punção lombar Discussão: A diplegia facial pode ocorrer no contexto de várias patologias, como tumores meníngeos ou do tronco encefálico, agentes infecciosos, síndrome de Guillain-Barré, patologias autoimunes, traumas, causas metabólicas ou congênitas. No caso descrito, após a exclusão das demais etiologias por exames laboratoriais e de imagem, e dada a apresentação clínica, a síndrome de Guillain-Barré continua sendo a causa mais provável, possivelmente secundária à infecção por SARS-CoV-2 pela positividade de IgG-SARS-CoV-2 após contato com um caso confirmado. Conclusão: O presente caso corrobora a hipótese de que a COVID-19 pode desencadear a síndrome de Guillain-Barré, especificamente na forma de diplegia facial, uma variante atípica que deve ser reconhecida para o diagnóstico e tratamento precoces dessa síndrome. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2021-12-28 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion text/html application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/32392 10.31053/1853.0605.v78.n4.32392 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 78 No. 4 (2021); 405-407 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 78 Núm. 4 (2021); 405-407 Revista da Faculdade de Ciências Médicas de Córdoba; v. 78 n. 4 (2021); 405-407 1853-0605 0014-6722 10.31053/1853.0605.v78.n4 spa https://revistas.unc.edu.ar/index.php/med/article/view/32392/35524 https://revistas.unc.edu.ar/index.php/med/article/view/32392/36594 Derechos de autor 2021 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0 |