Abstract Details

This case is presented to help clinicians recognize the potentially deadly association of COVID-19 and GBS/MFS overlap.

A 64-year-old male with a past medical history of hypertension and obesity developed nonspecific viral symptoms in January 2021, which abated after a few days without treatment.

Two weeks later, he presented to the ED with left facial droop and numbness, diplopia, bilateral leg weakness, and bilateral numbness and paresthesias of lower extremities ascending to the upper extremities. Physical exam showed left facial droop with impaired left eye closure, and abnormal finger-to-nose testing bilaterally. A stocking-and-glove pattern of decreased sensation in the hands and feet, 4/5 strength in both arms and legs, and absent lower extremity deep tendon reflexes was noted. MRI brain showed bilateral facial nerve meatal segments and facial ganglion enhancement. Labs showed CSF albuminocytologic dissociation and a positive nasopharyngeal PCR COVID-19 test, with a negative viral meningitis panel, VDRL, Lyme, and oligoclonal bands.

The patient was treated with 5 days of remdesivir and 10 days of corticosteroids for hypoxia due to COVID-19. Prednisone and acyclovir for initial Bell's palsy diagnosis demonstrated minimal improvement. After lumbar puncture, he was diagnosed with COVID-19 related GBS/MFS overlap. Intravenous immunoglobulin was administered for 5 days, leading to stabilization and gradual improvement of his neurologic symptoms. He was discharged to a skilled nursing facility with a walker. At 1-month outpatient follow up, he had minimal residual weakness and numbness in his proximal arms, legs, and bilateral hands.

This case highlights the importance of prompt recognition and treatment of post-COVID-19 complications, such as GBS. Diagnosis of this syndrome is critical for improved patient outcomes.