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 coronavirus 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 neuropathy 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 hospitalization for which she was put into mechanical ventilation. She was treated with high dose Methylprednisolone and standard medical therapy. IVIG or plasmapheresis 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 cannot 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.