Guillainbarré syndrome not responding to remdesivir, enoxaparin and high dose methylprednisolone in patient with covid 19 and eclampsia in pregnancy: A case report

Abstract

COVID-19 pandemic caused by severe acute respiratory syndrome coron-avirus 2 (SARS-CoV-2) has protean manifestations. Nervous system involvement though uncommon in COVID-19 can present with debilitating manifestations like necrotising encephalopathy, myopathy, seizure, peripheral neu-ropathy and Guillain Barré syndrome. In this case report, we report a case of 27 years old woman who presented to us with post partum eclampsia and developed acute flaccid quadriparesis 5 days after COVID-19 infection which was manifested as cough, anosmia and ageusia without fever. Patient developed dyspnoea followed by type 2 respiratory failure 8 days after hospitaliza-tion for which she was put into mechanical ventilation. She was treated with high dose Methylprednisolone and standard medical therapy. IVIG or plasma-pheresis could not be given due to non-availability. Patient expired in ICU after 18 days of hospital admission. SARS-COV-2 mainly infects the respiratory system of the body but it may have the neurotropic capacity and its ability to produce immune dysregulation can produce a cascade of inflammatory reactions in the nervous system. Guillain Barré syndrome is a heterogeneous disorder triggered by many viral infections and its development following COVID-19 infection can be attributed to the virus or immune response of the host against it. Possibility of COVID-19 infection triggering Guillain Barré syndrome can-not be ruled out. More studies regarding association of COVID-19 with the neurological disease may help in unraveling the neuro-invasion ability of the virus and to develop measures to prevent it.