Title : A case of SARS-CoV-2 induced guillain-Barre syndrome in a patient with concurrent bacterial infection while undergoing chemotherapy

Abstract:

Guillain-Barre Syndrome (GBS) represents a spectrum of lmmune-mediated neuropathies that affect 1 to 2 in 100,000 people annually worldwide. Known triggers include infections, vaccinations, trauma, bone marrow transplants, systemic diseases, and medications. Recently, SARS-CoV-2 infection has emerged as an etiology for GBS as well as other neuropathies. A 68-year-old woman undergoing neoadjuvant chemotherapy for breast cancer was admitted to the hospital with gait abnormality and bilateral lower extremity numbness and paresthesias.

She had recently been hospitalized for sepsis due to SARS-CoV-2 and Klebsiella pneumoniae urinary tract infection (UTI); she received remdesivir and ceftriaxone therapy for 3 days and she was discharged on ciprofloxacin. Notably, she was fully vaccinated agalnst SARS-CoV-2, however she was overdue for a booster dose. She subsequently developed worsening weakness of both lower extremities that ascended to involve her upper extremities as well. Lumbar puncture (LP) showed cerebrospinal fluid (CSF) studies consistent with albuminocytologic dissociation; combined with the clinical progression, we diagnosed her with GBS.

Plasmapheresis was initiated and she responded well. In this case, the patient’s diagnosis was complicated by several factors that could be potential triggers for GBS. Notably, her recent SARS-CoV-2 infection was the most likely trigger, however further study is warranted to determine the impact of SARS-CoV-2 severity and vaccination status on the development of GBS. We also considered if 1) concomitant Klebsiella pneumoniae lnfection, 2) concurrent use of paclitaxel, a chemotherapy agent known to cause peripheral neuropathy, and 3) chemotherapy-induced pancytopenia could have increased the risk of GBS in this patient with SARS-CoV-2 infection.

Objective: 

1. To illustrate the increased risk of developing GBS in patients with concurrent bacterial infections
2. To illustrate the increased risk of developing GBS in patients concurrently undergoing chemotherapy
3. To raise awareness of the increased risk of developing GBS in patients with chemotherapy-induced pancytopenia

Biography:

William Song, M.D. is a resident physician in Internal Medicine at the Ochsner Clinic Foundation in New Orleans, Louisiana, United States. He is clinically interested in the fields of infectious diseases, oncology, and critical care medicine.