Discussion:
Acute inflammatory demyelinating polyradiculoneuropathy or Guillain Barre syndrome is an immune-mediated nerve disease. Reported causes of the syndrome are campylobacter, mycoplasma, influenza, Zika virus, cytomegalovirus, HIV and lymphoma.12Coronavirus (SARS-COV 2) or COVID-19 is a rare cause of Guillain Barre syndrome.11-13 There are very few cases worldwide with COVID-19 causing GBS with some of these cases showing a good response to intravenous immunoglobulin.14 Other cases showed axonal neuropathy in the NCS, while others showed demyelinating neuropathy which is a common type in North America and Europe but thought to be rare in Africa. Other types of GBS according to the NCS classifications are acute motor axonal neuropathy (AMAN) and acute sensory motor neuropathy (ASMAN) which are more frequent in China, Japan and Mexico, and Miller Fisher syndrome (MFS) which is more common in Asia.15  In Sudan, we have mixed types of AIDP, AMAN, ASMAN and MFS.16 In this case, the patient first presented with weakness ascending in nature involving the upper limbs, neck and facial muscles on the same day, preceded by a high-grade fever with rigor and sweating, a dry cough, soreness, and chest discomfort with normal sensations, sphincter and flexor plantar responses. The patient came to the Emergency Department at the National Centre for Neurological Sciences in Khartoum with signs suggestive of COVID-19 infection-causing GBS. A patient workup was conducted including general investigations and complete blood counts which showed lymphopenia, high CRP and serum ferritin levels, normal arterial blood gases and the presence of a ground-glass appearance which is highly suggestive of COVID-19 in conjunction with the symptoms. A nasal swab was taken and sent to the lab. After that, treatment with intravenous immunoglobulin was started in doses of 28g per day. While the nasal swab result was pending, the patient showed immediate improvement after IVIG; the power changed from MRC grade 3 to MRC grade 2. Moreover, the patient received supportive management for COVID-19 in the form of paracetamol and vitamins. The patient reported that he was satisfied with the outstanding response to the treatment. A nerve conduction study showed a decrease in conduction velocity and delayed latencies with a dispersed response. This was due to the presence of demyelination, which is suggestive of the diagnosis of acute inflammatory demyelinating polyradiculoneuropathy or GBS. A follow-up with the patient after one month showed complete recovery , the patient walking without support.