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SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has, to date, impacted millions of people Patients with coronavirus disease 2019 (COVID-19) typically present with fever, cough, and shortness of breath We present this unique case to highlight the rare but serious neurological manifestations of COVID-19 CASE PRESENTATION: A 71-year-old male with a past medical history significant for hypertension, gout, and obesity presented with progressively worsening bilateral lower extremity weakness and a non-productive cough CT of the head showed no acute findings Chest x-ray showed findings indicative of COVID-19 pneumonia, bilateral pulmonary consolidation more prominent in the periphery of the lung bases SARS-CoV-2 PCR was positive, and the patient was admitted for COVID-19 pneumonia Physical exam was notable for diminished strength to lower extremities and decreased deep tendon reflexes noted to bilateral achilles and knees MRI of the brain showed no acute infarcts and no findings suggestive of encephalitis CT of the cervical spine and thoracic spine was negative for cervical hematoma and cord compression CPK to assess for myositis was normal Given the patient\'s clinical history of ascending paralysis with supporting physical exam findings, history of current COVID-19 infection, and negative imaging, a working diagnosis of Guillain-Barré Syndrome (GBS) was made The patient was placed on immune globulin intravenous (IVIG) therapy with noted improvement to lower extremity strength Once stabilized, the patient was successfully discharged to subacute rehabilitation DISCUSSION: GBS is a demyelinating disease characterized by progressive ascending weakness that begins distally and progresses proximally In severe cases, the respiratory muscles are paralyzed, necessitating the use of mechanical ventilation GBS commonly occurs after a triggering event, typically an infection The hypothesized mechanism of GBS is an auto-immune reaction The host immune system develops antibodies to the glycoproteins on the surface of the pathogen These surface glycoproteins are structurally similar to the protein components of peripheral nerves, causing the immune system to attack the peripheral nervous system CONCLUSIONS: To our knowledge, there have been three cases of GBS associated with COVID-19 described in the literature All three cases have described a parainfectious pattern of GBS that occurs while the patient is infected with COVID-19 Clinicians should be aware of the life-threatening neurological manifestations of COVID-19 Though exceedingly rare in comparison to the typical respiratory and systemic symptoms, neurological presenting symptoms should prompt clinicians to conduct a thorough assessment of the patient so that COVID-19 is not missed as a potential diagnosis and appropriate isolation precautions are implemented during this current pandemic Reference #1: Helm J, Kremer S, Merdji H, et al Neurologic features in severe SARS-CoV-2 infection N Engl J Med 2020;NEJMc2008597 Reference #2: Carod-Artal FJ Neurological complications of coronavirus and COVID-19 Rev Neurol 2020;70(9):311-322 Reference #3: Hughes RA, Wijdicks EF, Barohn R, et al Practice parameter: immunotherapy for Guillain-Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology 2003;61(6):736-740 DISCLOSURES: No relevant relationships by Mohammad Omar Butt, source=Web Response No relevant relationships by Margaret Mallari, source=Web Response No relevant relationships by Marija Tusheva, source=Web Response
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