Guillain-Barré syndrome in ulcerative colitis and SARS-CoV-2 infection: a case report and literature review

Figures & data

Table 1. Values of nerve conduction.

Nerve	Sites	Side	Latency (ms)	Amplitude (mV)	Conduction velocity (m/s)	F waves (ms)
Motor
Median	Elbow–wrist/APB	Right	3.2 (N<3.5)	4.2 (N>5)	46 (N>45)	25.3 (N<35)
		Left	3 (N<3.5)	4.6 (N>5)	48 (N>45)	26.6 (N<35)
Ulnar	Elbow–wrist/ADM	Right	3.5 (N<3.5)	4.3 (N>5)	47.5 (N>45)	28.7 (N<35)
		Left	3.2 (N<3.5)	4.2 (N>5)	46 (N>45)	29.1 (N<35)
Tibial	Knee–ankle/AH	Right	5.9 (N<5)	1.5 (N>2)	48 (N>45)	62.2 (N<55)
		Left	6.3 (N<5)	1.8 (N>2)	45 (N>45)	63 (N<55)
Peroneol	Fib head ankle/EDB	Right	5.5 (N<5)	0.8 (N>2)	42 (N>45)	68.2 (N<55)
		Left	5 (N<5)	1 (N>2)	43 (N>45)	67 (N<55)
Sensory
Median	Wrist/3rd finger	Right	3.7 (N<3.5)	4.5 (N<5)	42 (N>45)	–
		Left	3.8 (N<3.5)	5.8 (N<5)	45 (N>45)	–
Ulnar	Wrist/5th finger	Both	Not found	Not found	–	–
Superficial peroneal	Leg/ankle	Both	Not found	Not found	–	–
Sural	Calf/ankle	Both	Not found	Not found	–	–

APB: Abductor pollicis brevis; ADM: Abductor digitiminimi; AH: Abductor hallucis; EDB: Extensor digitorum brevis; Fib head: Fibular head; N: Normal values.

Table 2. Neurological findings during concomitant GBS-SARS-CoV-2 infection.

Neurologic symptoms or signs	Frequency
Abnormal plantar response	7.5%
Aphasia	12.9%
Ataxia	46.3%
Dysphagia	20.4%
Facial palsy, weakness or plegia	42.2%
Faecal incontinence	4.1%
Urinary difficulties	10.9%
Hypogeusia or ageusia	17.7%
Hyporeflexia or areflexia	84.4%
Hyposmia or anosmia	15.6%
Impaired somatic sensation	72.8%
Lumbar pain	15%
Myalgia	23.8%
Neck flexion weakness	7.5%

Adapted from Bentley SA, Ahmad S, Kobeissy FH, Toklu HZ. Concomitant Guillain–Barré syndrome and COVID-19: a meta-analysis of cases. Medicina (Kaunas) 58(12), 1835 (2022). Doi: 10.3390/medicina58121835 with permission from [3].

Table 3. Summary of published cases of association between UC and GBS compared to our case.

	Authors	Year of publication	Gender	Age at GBS Onset	Delay between UC onset and GBS	Treatment received before GBS onset	UC activity	Clinical features of GBS	Albuminocytologic dissociation	GBS electrophysiological form	GBS treatment	Outcome	Ref.
1	Torre RG et al.	2010	Male	74	GBS was inaugural preceded IBD onset by 2 months	None	Active with tuberculosis	Paraparesis	Absent	Axonal	IVIG	Partial improvement	[11]
2	Zimmerman J et al.	1985	Female	65	18 months	Sulfasalazine and oral corticosteroids	Remission	Tetraparesis Urinary disturbances Facial diplegia Dysphagia	Present	Demyelinating	Corticosteroids	Complete recovery	[12]
3			Male	58	12 years	Sulfasalazine	Remission	Areflexia Paraparesis Limb hypoesthesia Respiratory failure	Absent	Demyelinating	Corticosteroids	Complete recovery
4	Krystallis CS et al.	2009	Male	59	5 years	5 aminosalicylate	Active	Limb paresthesia	Present	Demyelinating	IVIG	Complete recovery	[13]
5	Liu Z et al.	2018	Male	31	3 months	Mesalazine + 5 aminosalicylate	Active	Quadriparesis	Present	Axonal	IVIG	Partial improvement	[14]
6	Saito M et al.	1994	Female	56	NA	5 aminosalicylate	Active with Rubella infection	Quadryparesis	NA	NA	Plasmapharesis	Complete recovery	[15]
7	Roca B et al.	1999	Female	69	30 years	5 aminosalicylate	Remssion Mild upper respiratory infection	Quadriparesis	Present	Demyelinating	IVIG	Complete recovery	[16]
8	Tominaga K et al.	2019	Male	39	GBS was inaugural and preceded IBD onset by 2 weeks	Was not yet under treatment	Active	Quadriparesis Unilateral VI and VII nerve paresis	Absent	Axonal	IVIG	Complete recovery	[17]
9	Bouchra A et al.	2009	Female	47	10 years	5 aminosalicylate	Remission	Quadriparesis	present	Axonal	IVIG	Partial improvement	[18]
10	Jayasundara et al.	2022	Male	24	2 years	None	Concomittent flare-up	Paraparesis areflexia	Present	NA	IVIG	Partial improvement	[19]
11	Our case		Female	30	4 months	Azathioprine	Active with SARS-CoV-2 infection	Quadriparesis	Absent	Axonal	IVIG	Partial improvement

IBD: Inflammatory bowel disease; IVIG: Intravenous immunoglobulin; NA: Not available; GBS: Guillain–Barré syndrome; UC: Ulcerative colitis.

Bentley SA, Ahmad S, Kobeissy FH, Toklu HZ. Concomitant Guillain-Barré syndrome and COVID-19: a meta-analysis of cases. Medicina (Kaunas) 58(12), 1835 (2022).

 PubMed Web of Science ®Google Scholar

de la Torre RG, Morís G, Martínez DP, Montes IC. Guillain-Barré syndrome, tuberculosis and inflammatory bowel disease: a multiple association. Int. Arch. Med. 3, 15 (2010).

 PubMedGoogle Scholar

Zimmerman J, Steiner I, Gavish D, Argov Z. Guillain-Barré syndrome: a possible extraintestinal manifestation of ulcerative colitis. J. Clin. Gastroenterol. 7(4), 301–303 (1985).

 PubMed Web of Science ®Google Scholar

Krystallis CS, Kamberoglou DK, Cheilakos GB, Maltezou MN, Tzias VD. Guillain-Barré syndrome during a relapse of ulcerative colitis: a case report. Inflamm Bowel Dis. 16(4), 555–556 (2010).

 PubMed Web of Science ®Google Scholar

Liu Z, Zhou K, Tian S, Dong W. Ulcerative colitis with Guillain-Barré syndrome: a case report. Medicine (Baltimore) 97(25), e11013 (2018).

 PubMed Web of Science ®Google Scholar

Saito M, Hozumi I, Kawakami A, Tsuji S. A case of post-rubella Guillain-Barré syndrome associated with ulcerative colitis. Rinsho Shinkeigaku 34(11), 1121–1124 (1994).

 PubMedGoogle Scholar

Roca B, Moreno I, Meneu E. Ulcerative colitis and acquired demyelinating neuropathy (Guillain-Barré syndrome). Neth. J. Med. 54(3), 129–130 (1999).

 PubMed Web of Science ®Google Scholar

Tominaga K, Tsuchiya A, Sato H et al. Co-existent ulcerative colitis and Guillain-Barré syndrome: a case report and literature review. Clin. J. Gastroenterol. 12(3), 243–246 (2019).

 PubMed Web of Science ®Google Scholar

Bouchra A, Benbouazza K, Hajjaj-Hassouni N. Guillain-Barre in a patient with ankylosing spondylitis secondary to ulcerative colitis on infliximab therapy. Clin. Rheumatol. 28(1), 53–55 (2009).

 PubMedGoogle Scholar

Jayasundara JMHD, Samarawickrama VT, Peiris R, Aponso T, Abeynayake D. Concomitant Guillain-Barré Syndrome in a young Sri Lankan male with severe ulcerative colitis. BMC Gastroenterol. 22(1), 411 (2022).

 PubMed Web of Science ®Google Scholar