Abstract Details Title Guillain-Barré Syndrome with Facial Diplegia Related to SARS-CoV-2 Infection: A Case with Concurrent West Nile Virus Infection Topic Infectious Disease Presentation(s) Infectious Disease Posters (7:00 AM-5:00 PM) Poster/Presentation Number 064 Objective We present a case of facial diplegia with limb paresthesia (FDP) in a 70-year-old female, demonstrating co-infection with SARS-CoV-2 virus and West Nile virus (WNV). Background FDP is a relatively rare variant of GBS, presenting as acute progressive bifacial weakness, paresthesia of the distal limbs, and decreased deep tendon reflexes. FDP has been seen in conjunction with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection. Design/Methods Clinical manifestations, CSF findings, MRI imaging results, and electrophysiological diagnostic data were analyzed. Results A 70-year-old woman was admitted to the hospital for new onset of slurred speech, bifacial weakness, and extremity paresthesia. Three weeks prior to the admission, she had contact with a confirmed COVID-19 patient. She developed fever and cough which resolved in 3 weeks. Two days prior to admission, she developed facial weakness, dysphagia and limb paresthesia. Her symptoms progressively worsened with development of slurred speech. On examination, she was noted to have severe bilateral facial weakness and was unable to completely close her eyes. She had dysesthesia in both hands, and equivocal sensation of the lower extremities. Areflexia was noted in the biceps, brachioradialis, and patella. The right patella and bilateral ankle reflexes were absent. She was tested for COVID-19, and was SARS CoV-2 positive. CSF study showed albuminocytological dissociation. Both serum and CSF were test positive for WNV IgM. MRI of the brain showed linear enhancement along the distal intracanalicular and labyrinthine segment of the bilateral facial nerves. MRI of spinal cord did not reveal any lesion. Nerve conduction studies (NCS) showed prolonged proximal and distal latency with significant slowing of conduction compatible with demyelinating polyradiculoneuropathy, no sign of WNV associated findings. She was treated with IVIG, and gradually recovered. Conclusions The neurological manifestations of COVID-19 remain puzzling. Our case report expands the range of possible neurologic manifestations of COVID-19. Authors/Disclosures Ning Zhong, MD (KP Medical Center) PRESENTER Dr. Zhong has nothing to disclose.