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ATYPICAL GUILLAIN-BARRÉ SYNDROME ASSOCIATED WITH COVID-19 IN A CHILD: A CASE REPORT

2024; Elsevier BV; Volume: 28; Linguagem: Inglês

10.1016/j.bjpt.2024.101028

1809-9246

Jakeline Godinho Fonseca, Aika Ribeiro Kubo, Juliana Melo do Prado, Amanda Lohanny Sousa Campos, Pollyanna Neta de Brito, Nayara Rodrigues Gomes de Oliveira,

Long-Term Effects of COVID-19

The SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2) became known worldwide as the cause of the disease COVID-19. COVID-19 can compromise the central nervous system, causing neurological disorders such as Guillain-Barré syndrome (GBS). GBS is triggered by viral and bacterial agents, defined as polyradiculoneuropathy of acute/subacute onset, with sensory manifestations, muscle weakness, temporary quadriparesis and even severe respiratory failure with respiratory and diaphragmatic muscle weakness. To report the case of a child diagnosed with COVID-19 and GBS and describe its clinical and functional evolution. Case report study, carried out from the collection of data from the medical records of a child admitted to the back-up Pediatric Intensive Care Unit for COVID-19 in a Brazilian hospital. A previously healthy 12-year-old boy started flu-like symptoms, followed by diarrhea and after 7 days he developed weakness in his hands and walking difficulty. Admitted with positive serology for COVID-19 with SARS-CoV-2 virus detected in the viral panel of CSF and nasal swab, laboratory and imaging tests without alterations. He was oriented, eupneic, had adequate vital signs, isochoric and photoreactive pupils, absence of nystagmus and alterations in facial sensitivity, preserved facial mimicry, tetrasegmental alteration, areflexia in lower limbs, hyporeflexia in upper limbs, absence of signs of pyramidal release, preserved tactile and painful sensitivity, uncharacteristic cerebrospinal fluid. Physical therapy diagnosis: eutonic neuroperipheral functional kinetic deficiency, preserved autonomic function, moderate reduction in strength, normal sensory functions, affecting limbs. Functional Status Scale classified with mild functional dysfunction. Electromyography was performed resulting in motor neuropathy, primarily axonal, symmetric of severe intensity and with severe associated axonal loss, with signs of active denervation. He received treatment with intravenous immunoglobulin at a standard dose for 4 days and gabapentin to treat neuropathic pain: physiotherapeutic treatment using active-assisted exercises, decubitus change training, respiratory muscle training, strength training, balance and assisted walking with perceptual-cognitive stimulus. He was discharged from the ICU after 6 days, showing improvement in his motor condition, walking with minimal assistance, with changes in gait, motor coordination and dynamic balance. After 18 days, he was discharged from the hospital with a score of 44 for peripheral muscle strength (Medical Research Council), maximum inspiratory pressure of 63 cmH²O, improved functionality, being able to perform activities of the daily routine, such as walking and climbing stairs independently. Few cases of GBS associated with COVID-19 in children have been reported in the world literature, leaving many questions about the mechanisms that influence the different factors for the development of the disease. Diagnosis and early intervention in these patients have shown favorable results, providing progressive clinical and functional improvement, but further studies regarding specialized protocols for the rehabilitation of these patients are still needed. This case report contributes to the knowledge regarding the characteristics and functional evolution of this syndrome associated with COVID-19 in children, due to the scarcity of publications to date.