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Abstract Details

Atypical Presentation of Guillain-Barré Syndrome (GBS) with Facial Diplegia and Retained Reflexes associated with COVID-19 Infection
Neuromuscular and Clinical Neurophysiology (EMG)
Neuromuscular and Clinical Neurophysiology (EMG) Posters (7:00 AM-5:00 PM)
122
To report an atypical presentation of GBS associated with COVID-19 infection.
Neurologic manifestations of COVID-19 such as ischemic stroke, GBS and headache are becoming widely recognized. GBS typically presents with ascending weakness and areflexia. Isolated facial diplegia is a rare phenotype of GBS. There are scarce reports of facial diplegia associated with COVID-19. We present an atypical presentation of GBS with facial diplegia and retained reflexes associated with COVID-19 infection.
A 43 year-old man with history of hypertension presented in April 2020 with three-day history of facial paralysis and mild paresthesia in distal extremities. Three weeks prior, he had self-resolving flu-like illness with fever, headache and generalized body pain for which mild COVID-19 infection was suspected. Exam was notable for bilateral peripheral facial nerve palsy and preserved deep tendon reflexes.
Patient declined inpatient admission for further evaluation and treatment due to fear of exposure to SARS-CoV-2 in the hospital. Patient consented to lumbar puncture in outpatient setting. CSF analysis revealed albuminocytologic dissociation with protein of 144 mg/dl and white blood cell count of 1 /ul. Laboratory work-up for Lyme disease, HIV, syphilis, HSV, Sjogren's disease, multiple sclerosis were negative. MRI brain showed subtle enhancement of seventh cranial nerves. Home infusion of intravenous immunoglobulin (IVIG, 50g daily for three days) was arranged and completed. Within 10 days, facial diplegia resolved. Patient never developed other neurological symptoms throughout his clinical course. Patient was not tested for SARS-CoV-2 during his quarantine prior to presentation, however SARS-CoV-2 antibodies were detected after completion of treatment.
This case demonstrates that GBS associated with COVID-19 infection can present with isolated facial diplegia, and significant benefit can be achieved with a short course of IVIG administered at home during a pandemic.
Authors/Disclosures
Puja Jain, MD
PRESENTER 		Dr. Jain has nothing to disclose.
Risako Shirane, MD, MSc (Yale University) Dr. Shirane has nothing to disclose.
DeWitt D. Pyburn, MD (Mt Sinai Beth Israel) Dr. Pyburn has nothing to disclose.