Guillain–Barré syndrome (GBS) is a potentially fatal, immune-mediated disease of the
peripheral nervous system that is usually triggered by infection. Only a small number
of cases of GBS associated with COVID-19 infection have been published. We report
here five patients with GBS admitted to the Neurology, Psychiatry, and Neurosurgery
Hospital, Assiut University/Egypt from July 1 to November 20, 2020. Three of the five
patients were positive for SARS-CoV-2 following polymerase chain reaction (PCR) of
nasopharyngeal swabs on day of admission and another one had a high level of IgM
and IgG; all had bilateral ground-glass opacities with consolidation on CT chest scan
(GGO) and lymphopenia. All patients presented with two or more of the following:
fever, cough, malaise, vomiting, and diarrhea with variable duration. However, there
were some peculiarities in the clinical presentation. First, there were only 3 to 14 days
between the onset of COVID-19 symptoms and the first symptoms of GBS, which
developed into flaccid areflexic quadriplegia with glove and stocking hypoesthesia. The
second peculiarity was that three of the cases had cranial nerve involvement, suggesting
that there may be a high incidence of cranial involvement in SARS-CoV-2-associated
GBS. Other peculiarities occurred. Case 2 presented with a cerebellar hemorrhage
before symptoms of COVID-19 and had a cardiac attack with elevated cardiac enzymes
following onset of GBS symptoms. Case 5 was also unusual in that the onset began
with bilateral facial palsy, which preceded the sensory and motor manifestations of
GBS (descending course). Neurophysiological studies showed evidence of sensorimotor
demyelinating polyradiculoneuropathy, suggesting acute inflammatory polyneuropathy
(AIDP) in all patients. Three patients received plasmapheresis. All of them had either
full recovery or partial recovery. Possible pathophysiological links between GBS and
COVID-19 are discussed.