Post COVID-19 Guillain–Barre syndrome presents as sensory dominant neuropathy with reversible conduction failure

Abstract

Guillain–Barré syndrome (GBS) has several clinical variants. The sensory presentations of GBS are atypical but well-recognized. We report a patient who presented with predominantly sensory symptoms associated with reversible conduction failure (RCF). RCF is a well-defined neurophysiological abnormality noted mainly in axonal GBS and may be misinterpreted as evidence of demyelination. A 25-year-old woman presented 2 weeks after a coronavirus 2019 infection with acute sensory symptoms, distal allodynia, mild weakness, and mild hyporeflexia in her upper limbs. A nerve conduction study (NCS) showed delayed motor distal latencies, and lumbar puncture confirmed cytoalbuminologic dissociation. After excluding other etiologies, she was diagnosed with GBS, treated with an IV immunoglobulin course, and showed remarkable recovery. Results of a repeat NCS were consistent with RCF and confirmed the presence of axonal GBS. Increased awareness of sensory GBS and RCF is expected to improve the diagnosis and management of atypical GBS presentations.