Publication

Abstract : We read with great interest the article by Kaur et al.1 describing the aggressive clinical course in a child with COVID-19–associated transverse myelitis. We would like to share our experience with a child with COVID-19–associated Guillain-Barre syndrome (GBS). This developmentally normal four-year-old girl presented with a two-day history of pain in the neck, neck floppiness, change in voice, drooling, and bilateral arm weakness. Two weeks before this illness, she had a mild febrile illness without any focus. There was no history of confirmed COVID-19 or COVID-19 vaccination. Examination revealed facial diplegia, bulbar weakness, neck weakness, symmetric proximal-predominant flaccid quadriparesis (upper limb weakness > lower limb), respiratory muscle weakness (requiring mechanical ventilation), and generalized areflexia, without any ophthalmoplegia, encephalopathy, meningism, or other involvement. Inflammatory markers and SARS-CoV-2 polymerase chain reaction were negative. Serum IgG antibodies for SARS-CoV-2 were strongly positive. Nerve conduction study revealed markedly reduced amplitudes, abnormally prolonged distal latencies, and normal conduction velocities in motor nerves with normal sensory study. Cerebrospinal fluid (CSF; day three) showed mildly elevated protein (51 mg/dl, normal: 15-40 mg/dl), while CSF viral panel was negative. Spine magnetic resonance imaging revealed contrast enhancement of the lumbosacral nerve roots (D12 to S1), while brain imaging was normal (Fig). Considering COVID-19–associated GBS (postinfectious), she was managed with intravenous immunoglobulin (2 g/kg over five days). She responded well and was discharged by day ten (off ventilator, walking with support at discharge).