Improved a Guillain-Barre Syndrome Patient with Positive PCR Test for Coronavirus in Cerebrospinal Fluid After Plasmapheresis: A Case Report

Introduction: Coronavirus disease 2019 (COVID-19), started in December 2019, affects many organs and systems of the body, such as the central nervous system. Case Presentation:We describe a case of a 66-year-old female patient with positive results for COVID-19 using real-time PCR (RT-PCR) testing from her cerebrospinal fluid (CSF) and the coronavirus antibodies (Ig G and Ig M) using serology test. Her clinical presentation showed the misbalance and acute weakness of upper and lower limbs with preference of proximal parts of the limbs, pinprick, and the absence of deep tendon reflexes. Taken together, these symptoms, neurological tests and the result of CSF analysis (high protein) were in favor of Guillain-Barre syndrome (GBS). In addition, because the neurological symptoms worsted four days after hospitalization, plasmapheresis was started over the course of 8 days (on every alternate day) with a volume of 2000 mL. Although the results of electromyogram (EMG) - nerve conduction velocity (NCV) following plasmapheresis showed the motor and sensory neuropathy, which was generally accompanied by demyelination, but it leads to the recovery of upper and lower limbs from 2/5 to 4/5 and improvement of neck flexor muscles from 3/5 to 5/5. Conclusions: GBS should be considered as a neurological outcome of COVID-19. In addition, regarding the beneficial effects of plasmapheresis on GBS (following coronavirus infection), it can be suggested as a part of the treatment protocol in these patients.