Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 151 No. 3738 (2021)

Post-COVID-19 bifacial weakness and paraesthesia: a case report

  • Johann Stuby
  • René Roth
  • Nico Strecker
  • Jonas Teubner
  • Alain Rudiger
DOI
https://doi.org/10.4414/SMW.2021.w30066
Cite this as:
Swiss Med Wkly. 2021;151:w30066
Published
21.09.2021

Summary

OBJECTIVES: We present a patient with bifacial weakness and paraesthesia subtype of Guillain-Barré syndrome (GBS), which occurred 1 month after a SARS-CoV-2 infection. While GBS as complication of SARS-CoV-2 infection has been described many times, only a few cases of post-COVID-19 bifacial weakness and paraesthesia are known to date.

RESULTS: A 59-year-old man presented with thoracoradicular pain, paraesthesias of hands and feet, as well as progressive bilateral facial palsy. Neurological examination revealed a hyporeflexia of his lower limbs and hypoaesthesia of his hands and feet. Clinical and electrophysiological findings as well as CSF analysis were consistent with bifacial weakness and paraesthesia. The patient’s condition improved promptly after 5 days of intravenous immunoglobulin therapy.

DISCUSSION: We suspect bifacial weakness and paraesthesia to be a possible post-infectious complication of COVID-19. Hence, it is a differential diagnosis of facial nerve palsy in association with SARS-CoV-2 infection. Considering the rarity of GBS and bifacial weakness and paraesthesia, it appears unlikely that bigger trials elucidating the causal relation between them and SARS-CoV-2 infection will be available in the future.

References

  1. Hutchins KL, Jansen JH, Comer AD, Scheer RV, Zahn GS, Capps AE, et al. COVID-19–associated bifacial weakness with paresthesia subtype of Guillain-Barré syndrome. AJNR Am J Neuroradiol. 2020 Sep;41(9):1707–11. https://doi.org/10.3174/ajnr.A6654
  2. Aasfara J, Hajjij A, Bensouda H, Ouhabi H, Benariba F. A unique association of bifacial weakness, paresthesia and vestibulocochlear neuritis as post-COVID-19 manifestation in pregnant women: a case report. Pan Afr Med J. 2021 Jan;38(30):30.
  3. World Health Organization . Therapeutics and COVID-19: living guideline 6 July 2021. Available online: https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2021.2 (accessed on 2021 August 14) [
  4. Wakerley BR, Yuki N. Isolated facial diplegia in Guillain-Barré syndrome: bifacial weakness with paresthesias. Muscle Nerve. 2015 Dec;52(6):927–32. https://doi.org/10.1002/mus.24887
  5. Kumar P, Charaniya R, Bahl A, Ghosh A, Dixit J. Facial Diplegia with Paresthesia: An Uncommon Variant of Guillain-Barre Syndrome. J Clin Diagn Res. 2016 Jul;10(7):OD01–02. https://doi.org/10.7860/JCDR/2016/19951.8092
  6. Susuki K, Koga M, Hirata K, Isogai E, Yuki N. A Guillain-Barré syndrome variant with prominent facial diplegia. J Neurol. 2009 Nov;256(11):1899–905. https://doi.org/10.1007/s00415-009-5254-8
  7. 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 Oct;51(4):1110–5. https://doi.org/10.1212/WNL.51.4.1110
  8. Costello F, Dalakas MC. Cranial neuropathies and COVID-19: neurotropism and autoimmunity. AAN Enterprises; 2020.
  9. 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):1–38. https://doi.org/10.1007/s00415-020-10124-x
  10. Sriwastava S, Kataria S, Tandon M, Patel J, Patel R, Jowkar A, et al. Guillain Barré Syndrome and its variants as a manifestation of COVID-19: A systematic review of case reports and case series. J Neurol Sci. 2021 Jan;420:117263. https://doi.org/10.1016/j.jns.2020.117263
  11. Palaiodimou L, Stefanou MI, Katsanos AH, Fragkou PC, Papadopoulou M, Moschovos C, et al. Prevalence, clinical characteristics and outcomes of Guillain-Barré syndrome spectrum associated with COVID-19: A systematic review and meta-analysis. Eur J Neurol. 2021 Oct;28(10):3517–29. https://doi.org/10.1111/ene.14860
  12. Fragiel M, Miró Ò, Llorens P, Jiménez S, Piñera P, Burillo G, et al.; SIESTA (Spanish Investigators in Emergency Situations Team) network. Incidence, clinical, risk factors and outcomes of Guillain-Barré in Covid-19. Ann Neurol. 2021 Mar;89(3):598–603. https://doi.org/10.1002/ana.25987
  13. Keddie S, Pakpoor J, Mousele C, Pipis M, Machado PM, Foster M, et al. Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barré syndrome. Brain. 2021 Mar;144(2):682–93. https://doi.org/10.1093/brain/awaa433
  14. Awong IE, Dandurand KR, Keeys CA, Maung-Gyi FA. Drug-associated Guillain-Barré syndrome: a literature review. Ann Pharmacother. 1996 Feb;30(2):173–80. https://doi.org/10.1177/106002809603000212
  15. Ali AK. Peripheral neuropathy and Guillain-Barré syndrome risks associated with exposure to systemic fluoroquinolones: a pharmacovigilance analysis. Ann Epidemiol. 2014 Apr;24(4):279–85. https://doi.org/10.1016/j.annepidem.2013.12.009

Most read articles by the same author(s)