COVID-19 and Neonatal Guillain-Barré Syndrome: Exploring a Possible Causal Link With Review of Literature.
Choudri Muzafar Paswal, Neeraj Gupta, Swasthi Kabi Satpathy et al.
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Case in brief
A 24-day-old term male developed progressive hypotonia, weak cry, and respiratory distress after a febrile illness with gastrointestinal symptoms. Examination showed areflexia, cranial nerve involvement, and generalised weakness. Cerebrospinal fluid demonstrated albuminocytologic dissociation, MRI showed cauda equina enhancement, and nerve conduction studies identified motor-sensory polyneuropathy, supporting Guillain-Barré syndrome. Anti-SARS-CoV-2 IgG was high (>4000 IU/mL), while maternal titres were negative. Following two courses of intravenous immunoglobulin, he recovered fully and was developmentally normal at 2-year follow-up.
What made this case unusual
The report describes postnatally acquired neonatal Guillain-Barré syndrome potentially associated with SARS-CoV-2, with high infant anti-SARS-CoV-2 IgG and negative maternal titres.
Diagnostic / clinical pearl
Consider Guillain-Barré syndrome in a floppy neonate with a postinfectious presentation; areflexia and supportive cerebrospinal fluid, imaging, and nerve conduction findings can help establish the diagnosis.