209 - Blast from the Past: A Case of Recurrent AIDP in the Setting of COVID-19 Infection

Case Diagnosis: Recurrent AIDP Secondary to COVID-19

Case Description: A 34-year-old male with previous AIDP (acute inflammatory demyelinating polyneuropathy) secondary to COVID-19 presented with lower extremity weakness, paresthesias, and ptosis. He had previously achieved complete neuromuscular recovery from AIDP and never received COVID-19 vaccinations. Serology testing for COVID-19 was positive. CSF studies revealed elevated total protein with a normal cell count. Electrodiagnostic studies showed prolonged F-wave responses in the left peroneal (68.15 ms) and tibial nerves (81.99 ms). EMG studies revealed polyphasic units with increased motor unit amplitude and duration of the left extensor hallucis longus. Treatment with IVIG was started for Guillain-Barre Syndrome (GBS). After two rounds of treatment his symptoms improved. Following hospitalization, the patient completed an inpatient rehabilitation program and achieved complete neuromuscular recovery.

Discussions: Current literature supports an association between COVID-19 infection and recurrent GBS.^1,2 GBS refers to a group of post-infectious polyneuropathies typically occurring following a respiratory or gastrointestinal infection. The pathogenesis is hypothesized to be secondary to molecular mimicry causing an exaggerated autoimmune response resulting in axonal degeneration of peripheral nerves. Clinically, this manifests as ataxia, areflexia, weakness, and opthalmoplegia.³



Treatment is supportive; however, severe cases can result in dysphagia or respiratory failure and often require plasma exchange therapy and intubation. Efficiently establishing a diagnosis and initiating treatment with IVIG has been shown to impact neuromuscular recovery.⁴ AIDP was confirmed by the presence of cytoalbuminologic dissociation on CSF studies, which is specific for GBS.⁵



Electrodiagnostic findings supported the diagnosis and facilitated rapid initiation of treatment. EMG findings suggested chronic changes secondary to denervation and reinnervation from previous AIDP.⁶

Conclusions: This case supports current literature suggesting an increasing incidence of recurrent AIDP secondary to COVID-19 infection. Additionally, it highlights the utility of electrodiagnostic evaluation when suspecting AIDP to allow for rapid initiation of treatment to help facilitate complete neuromuscular recovery.