Study: COVID-19 can trigger paralytic disease
AHN neurologist authored case study
An Allegheny General Hospital neurologist has reported what’s believed to be the first official U.S. case of COVID-19 triggering Guillain-Barre syndrome, with that case involving a 54-year-old man.
Dr. Sandeep Rana successfully treated the patient who, he said, has fully recovered from the infection and gradually is improving from the weakness caused by the syndrome.
Typically such cases involve numbness and paralysis that can last six months to a year, with a small percentage of patients experiencing long-term or even lifelong weakness or paralysis.
The case study, with Dr. Rana as chief author, was published in the June issue of the Journal of Clinical Neuromuscular Disease.
During the COVID-19 infection, doctors and researchers have been publishing case accounts about different treatments and unusual or unexpected impacts of the infection to keep other doctors apprised of trends during the pandemic.
Guillain-Barre typically involves an autoimmune attack against the myelin sheaths that insulate and protect nerves throughout the body, with the syndrome mostly limited to impacts in the arms, legs and face.
Roughly two-thirds of patients with the syndrome contract the illness shortly after a severe viral, respiratory or bacterial infection, an
Allegheny Health Network report says.
Patients diagnosed with the
syndrome, often known as GBS, “will experience progressive, ascending, symmetrical paralysis of the arms and legs, with or without cranial nerve involvement,” the AHN report says.
Those who develop the syndrome are treated by a plasma exchange therapy — using donor plasma to induce a healthy immune response in the patient — or intravenous immunoglobulins (or antibodies), which is a treatment that is widely accessible, Dr. Rana said.
For many, the disorder initially presents itself with tingling or numbness in the lower portion of the body and advances upward, with muscles losing complete ability to respond to stimuli. In extremely severe cases, it says, patients may progress to total paralysis.
Dr. Rana said his patient’s syndrome differed from those triggered by other viruses by occurring simultaneously with COVID virus infection, whereas cases of GuillianBarre caused by other viral infections tend to occur three to four weeks following the patient’s recovery.
Cases of COVID-19 causing Guillain-Barre have been documented in China, Italy and France, he said, with some discussions among U.S. physicians about cases they were aware of.
But Dr. Rana said he believes his team’s report to be the first officially documented case caused by the coronavirus in the United States.
In fairly rare instances, he said, antibodies the immune system generates against viral or bacterial infections end up attacking the nerves because receptors (known as antigens) on their surfaces are similar.
The antigens on the SARS-CoV-2 — the virus that causes COVID-19 — are the rod-like spikes, apparent in photographs of the virus, that create the crown-like appearance characteristic of all corona (crown) viruses.
“The antibody that protects us sometimes crossreacts,” Dr. Rana said. “Rather than attack the virus, it attacks the nerve because they share (similar) antigens.
“It’s not clear why the immune system goes awry in these patients developing GBS,” he said.
“Although the number of documented cases internationally is notably small to date, it’s not completely surprising that a COVID-19 diagnosis may lead to a patient developing GBS,” he said in the AHN release. “In fact, similar connections were made during the 2016 Zika virus outbreak.”