COVID-19 Sonrası Akut Başlangıçlı Kronik İnflamatuar Demiyelinizan Polinöropati

Year 2022, , 95 - 97, 30.04.2022

Miruna Florentina Ateş , Sude Kendirli Sibel Karşıdağ , Şevki Sahin , Nilgün Çınar

https://doi.org/10.18678/dtfd.1034475

Abstract

Koronavirüs hastalığı 2019’u (coronavirus disease 2019, COVID-19) takiben Guillain Barre Sendromu (GBS) vakaları bildirilmiştir. Burada farklı yönleri nedeniyle literatüre katkı sağlaması açısından COVID-19 sonrası GBS’den kronik inflamatuar demiyelinizan polinöropatiye (chronic inflammatory demyelinating polyneuropathy, CIDP) evrilen bir olguyu tanımladık. Akut başlayan mikst tipte polinöropati olgusunun beyin omurilik sıvısı incelemesinde albüminositolojik dissosiasyon saptanmadı. Hastaya yükleme dozu ve altı ay boyunca aylık idame intravenöz immünglobulin (IVIG) verildi. Kan ferritin düzeyleri klinik iyileşme ile paralel tedricen azaldı. IVIG tedavisi sonlandırıldıktan 4 ay sonra bulgular tekrarladı, CIDP gelişti ve IVIG tedavisine devam edildi. COVID-19 sonrası GBS hastalarının uzun süreli takibi nüks ve kroniklik açısından önemlidir. Bu olguların klinik takibinde ferritin düzeyi biyokimyasal bir belirteç olabilir.

Keywords

COVID-19, GBS, ferritin, aksonal, nüks, prognoz

Acute Onset Chronic Inflammatory Demyelinating Polyneuropathy Following COVID-19

Abstract

The cases of Guillain Barre Syndrome (GBS) have been reported following the coronavirus disease 2019 (COVID-19). Here, we describe a case that evolved from GBS to chronic inflammatory demyelinating polyneuropathy (CIDP) after COVID-19 in terms of contributing to the literature due to its different aspects. In the cerebrospinal fluid examination of the acute onset mixed type polyneuropathy case, albuminocytological dissociation was not detected. The patient was given a loading dose and monthly maintenance intravenous immunoglobulin (IVIG) for six months. Blood ferritin levels gradually decreased in parallel with clinical improvement. Four months after the IVIG treatment was terminated, the findings recurred and the CIDP was developed and IVIG treatment was continued. Long-term follow-up of post-COVID-19 GBS patients is important in terms of recurrence and chronicity. Ferritin level may be a biochemical marker in the clinical follow-up of these cases.

Keywords

COVID-19, GBS, ferritin, axonal, recurrence, prognosis

References

• Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-90.
• Jacobs BC, Rothbarth PH, van der Meché FG, Herbrink P, Schmitz PI, de Klerk MA, et al. The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study. Neurology. 1998;51(4):1110-5.
• Abu-Rumeileh S, Abdelhak A, Foschi M, Tumani H, Otto M. Guillain-Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol. 2021;268(4):1133-70.
• Caress JB, Castoro RJ, Simmons Z, Scelsa SN, Lewis RA, Ahlawat A, et al. COVID-19-associated Guillain-Barré syndrome: The early pandemic experience. Muscle Nerve. 2020;62(4):485-91.
• Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barre´ syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol. 2020;19(5):383-4.
• Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K. Neurological manifestations of COVID-19 and other coronavirus infections: a systematic review. Clin Neurol Neurosurg. 2020;194:105921.
• Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. Guillain-Barré Syndrome Associated with SARS-CoV-2. N Engl J Med. 2020;382(26):2574-6.
• Brettschneider J, Petzold A, Süssmuth S, Tumani H. Cerebrospinal fluid biomarkers in Guillain-Barré syndrome--where do we stand? J Neurol. 2009;256(1):3-12.
• Yamagishi Y, Suzuki H, Sonoo M, Kuwabara S, Yokota T, Nomura K, et al. Markers for Guillain-Barré syndrome with poor prognosis: a multi-center study. J Peripher Nerv Syst. 2017;22(4):433-9.
• Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain. 2014;137(Pt 1):33-43.
• Sriwastava S, Kataria S, Tandon M, Patel J, Patel R, Jowkarf A, et al. Review Article Guillain-Barr´e Syndrome and its variants as a manifestation of COVID-19: A systematic review of case reports and case series. J Neurol Sci. 2021;420:117263.
• Torti FM, Torti SV. Regulation of ferritin genes and protein. Blood. 2002;99(19):3505-16.
• Lino K, Guimarães GMC, Alves LS, Oliveira AC, Faustino R, Fernandes CS, et al. Serum ferritin at admission in hospitalized COVID-19 patients as a predictor of mortality. Braz J Infect Dis. 2021;25(2):101569.
• Caricchio R, Gallucci M, Dass C, Zhang X, Gallucci S, Fleece D, et al.; Temple University COVID-19 Research Group. Preliminary predictive criteria for COVID-19 cytokine storm. Ann Rheum Dis. 2021;80(1):88-95.
• Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020;58(7):1021-8.
• Grand'Maison F, Feasby TE, Hahn AF, Koopman WJ. Recurrent Guillain-Barré syndrome. Clinical and laboratory features. Brain. 1992;115(Pt 4):1093-106.
• Kuitwaard K, van Koningsveld R, Ruts L, Jacobs BC, van Doorn PA. Recurrent Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry. 2009;80(1):56-9.
• McDonnell EP, Altomare NJ, Parekh YH, Gowda RC, Parikh PD, Lazar MH, et al. COVID-19 as a trigger of recurrent Guillain-Barré syndrome. Pathogens. 2020;9(11):965.
• Van den Bergh PY, Hadden RD, Bouche P, Cornblath DR, Hahn A, Illa I, et al.; European Federation of Neurological Societies; Peripheral Nerve Society. European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society - first revision. Eur J Neurol. 2010;17(3):356-63.
• Suri V, Pandey S, Singh J, Jena A. Acute-onset chronic inflammatory demyelinating polyneuropathy after COVID-19 infection and subsequent ChAdOx1 nCoV-19 vaccination. BMJ Case Rep. 2021;14(10):e245816.
• Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR. et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019;15(11):671-83.