A new coronavirus, the severe acute respiratory distress syndrome–coronavirus-2 (SARS-CoV-2/ COVID-19), has spread fast throughout the world, leading to high morbidity and mortality . COVID-19 is chiefly a respiratory infection, and the symptoms are related to the age and underlying medical condition of the patient and the immune system . An increasing body of information reported neurological complications of COVID-19, including headache, dizziness, confusion, myalgia, and loss of taste and smell .
Mao et al. assessed neurological symptoms in 214 patients infected with COVID-19, and found that 36.4% of the patients exhibited neurological issues ranging from headache, dizziness, hyposmia, and muscle damage, to ischemic stroke . Guillain–Barré syndrome (GBS) is an autoimmune disease of the peripheral nerves and nerve roots (polyradiculoneuropathy) that is usually caused by various infections such as Campylobacter jejuni, Epstein–Barr virus, influenza, and Zika virus [5, 6]. Miller Fisher syndrome (MFS) is a rare subtype of GBS and usually presents with at least two of the following features: ophthalmoplegia, areflexia, and ataxia. Some patients have weakness of the face, tongue, and swallowing muscles, as well as micturition disturbance. Others also develop weakness of the limbs and breathing muscles, and are then considered to have GBS-MFS overlap syndrome [7, 8].
GBS is characterized by ascending flaccid symmetrical limb paralysis with areflexia, sensory symptoms, and often involvement of the cranial nerves. Recently, some cases of GBS were reported in patients infected with COVID-19 [9,10,11]. We have little understanding of how COVID-19 infection results in GBS, and it needs to be investigated further. Although GBS syndrome is rare, the early diagnosis and treatment of GBS can considerably improve outcomes and avoid the need for ventilatory support. Here we report an acute motor sensory axonal neuropathy (AMSAN) case of GBS overlapped with MFS in a patient with COVID-19.