Guillain-Barré Syndrome in a Child With COVID-19 Infection Molly Curtis, MD, a Samina Bhumbra, MD, b,c Marcia V. Felker, MD, d Brittany L. Jordan, MD, d Josephine Kim, DO, c Michael Weber, MD, e Matthew L. Friedman, MD, MSCR f abstract Guillain-Barré syndrome (GBS) is characterized by a monophasic, ascending, and symmetrical paralysis with areflexia that progresses over days to weeks. It is typically a postinfectious autoimmune process that leads to destruction of myelin. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), originated in Wuhan, China, in late 2019 and rapidly spread around the world, causing a pandemic of novel coronavirus disease 2019 (COVID-19). There have been scattered reports of adults with possible GBS and concurrent evidence of COVID-19, but no previous reports in children. The patient is an 8-year-old boy who presented to the emergency department with progressive, ascending weakness with areflexia. He was intubated for airway protection because of poor secretion control. MRI of the spine revealed abnormal enhancement of posterior nerve roots. A lumbar puncture revealed albuminocytologic dissociation with 1 nucleated cell per mm 3 and a protein level of 620 mg/dL. Electrodiagnostic findings were compatible with sensorimotor demyelinating polyneuropathy. The lumbar puncture, MRI, and electrodiagnostics were all consistent with GBS. Results of SARS-CoV-2 nucleic acid amplification and SARS-CoV-2 immunoglobulin G antibody tests were positive. Treatment was initiated with intravenous immunoglobulin; he received a total of 2 g/kg. His neurologic examination revealed improvement in the subsequent days. He was extubated after 4 days of intubation. This case is the first reported case of a child with GBS in the setting of an acute COVID- 19 infection. This case reveals the wide scope of presentations of COVID-19 and postinfectious processes. Clinicians should constantly have a high level of suspicion for COVID-19. Guillain-Barré syndrome (GBS) is the most common cause of severe, acute weakness in children, and acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common subtype in the western world. 1 GBS is characterized by a monophasic, ascending, and symmetrical paralysis that progresses over days to weeks and is associated with areflexia. AIDP is typically a postinfectious autoimmune process believed to be caused by molecular mimicry to peripheral nerves leading to inflammation and destruction of myelin. Preceding infection can be identified in the majority of cases. The most common infectious triggers are minor respiratory illness, but gastrointestinal illnesses, other viral syndromes, and immunizations have also been associated with GBS. 2 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), originated in Wuhan, China, in late 2019 and rapidly spread around the world, causing a pandemic of novel coronavirus disease 2019 (COVID-19). The majority of pediatric disease is asymptomatic, but the common clinical a Division of Pediatric Emergency Medicine and f Division of Pediatric Critical Care and b Ryan White Center for Pediatric Infectious Disease and Global Health, c Department of Pediatrics, Indiana University and Riley Hospital for Children, Indianapolis, Indiana; and d Departments of Neurology and e Emergency Medicine, Indiana University, Indianapolis, Indiana Drs Curtis, Bhumbra, Jordan, Friedman, Felker, Kim, and Weber conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. DOI: https://doi.org/10.1542/peds.2020-015115 Accepted for publication Oct 13, 2020 Address correspondence to Matthew L. Friedman, MD, MSCR, Division of Pediatric Critical Care, Indiana University and Riley Hospital for Children, 705 Riley Hospital Dr, Phase 2, Room 4900, Indianapolis, IN 46022. E-mail: friedmml@iu.edu PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2021 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: Dr Bhumbra is supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (grant T32 AI07637) for work unrelated to this study. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. To cite: Curtis M, Bhumbra S, Felker MV, et al. Guillain-Barré Syndrome in a Child With COVID-19 Infection. Pediatrics. 2021;147(4):e2020015115 PEDIATRICS Volume 147, number 4, April 2021:e2020015115 CASE REPORT Downloaded from http://publications.aap.org/pediatrics/article-pdf/147/4/e2020015115/1181798/peds_2020015115.pdf by guest on 23 February 2022