A rare case of Guillain-Barré syndrome presenting with COVID-19 infection in a six-year-old child

Background and aims: Guillain Barre syndrome (GBS) is an acute inflammatory immune-mediated polyradiculoneuropathy characterized by rapidly progressing ascending weakness and hypo or areflexia. Severe acute respiratory syndrome coronavirus 2 (SARS COV-2) originating from Wuhan is spreading worldwide, and little information is available on its neurotropic characteristics. We report the first case of COVID-19 associated with GBS in a child from Santiago, Dominican Republic. Methods: Case report. Results: A six-year-old girl presented to our hospital with the complaints of cough, generalized weakness and unsteady gait. She had progressive weakness of distal lower extremities evolving to the upper limbs leading to quadriparesis. She also had walking and speaking difficulties. Her illness started with an upper respiratory tract infection one week back. Except for the prior respiratory illness, her past medical history was unremarkable. Physical examination revealed absent tendon reflex, weakness in the lower limbs greater than the arms. The sensory system was intact. Cranial nerves were also intact. Cerebrospinal fluid (CSF) revealed elevated proteins with typical albuminocytologic dissociation. CSF culture was negative. Four extremities electroneuromyography was performed and showed signs of acute polyradiculoneuropathy (Table 1). A PCR test for SARS-CoV-2 infection was positive. She was treated with intravenous immunoglobulins (IVIg) and recovered completely. Conclusion: We conclude that although the incidence of COVD-19 in children is low, paediatricians must consider it while looking at patients presenting with acute flaccid paralysis and a recent history of respiratory tract illness. A thorough clinical and electrophysiological evaluation must be carried out for timely diagnosis and efficient management of these patients.