r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2021-26-6-43-51r-n-j-243Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSСочетание острого поперечного миелита и синдрома Гийена–Барре у больного с СOVID-19Аcute transverse myelitis and Guillain – Barre overlap syndrome in a patient with СOVID-19https://orcid.org/0000-0003-4595-2614РуинаЕ. А.RuinaE. A.

Нижний Новгород

 

Nizhny Novgorod

ekaterina_ruina@mail.ruhttps://orcid.org/0000-0002-6256-3429ГригорьеваВ. Н.GrigoryevaV. N.

Нижний Новгород

Nizhny Novgorod

vrgr@yandex.ruhttps://orcid.org/0000-0001-5461-8525ЛесниковаА. А.LesnikovaA. A.

Нижний Новгород

Nizhny Novgorod

lesnikowa.alyona2018@yandex.ruhttps://orcid.org/0000-0002-4768-1355БеляковК. М.BeliakovK. M.

Нижний Новгород

Nizhny Novgorod

kirmih@mail.ruФГБОУ ВО «Приволжский исследовательский медицинский университет» Минздрава РоссииРоссияFederal State Budgetary Educational Institution of Higher Education “Privolzhsky Research Medical University” of the Ministry of Health of the Russian FederationRussian FederationФГБОУ ВО «Приволжский исследовательский медицинский университет» Минздрава России; ГБУЗ НО «Нижегородская областная клиническая больница им. Н.А. Семашко»РоссияFederal State Budgetary Educational Institution of Higher Education “Privolzhsky Research Medical University” of the Ministry of Health of the Russian Federation ; Nizhny Novgorod Regional Clinical Hospital named after N.A. SemashkoRussian Federation2021060120222664351Copyright © Руина Е.А., Григорьева В.Н., Лесникова А.А., Беляков К.М., 20222022Руина Е.А., Григорьева В.Н., Лесникова А.А., Беляков К.М.Ruina E.A., Grigoryeva V.N., Lesnikova A.A., Beliakov K.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/243

В статье представлено описание случая сочетанного развития острого поперечного миелита и синдрома Гийена–Барре (СГБ) («перекрестного синдрома») у 42-летнего больного c коронавирусной инфекцией (Coronavirus disease 2019, СOVID-19). У больного на 5-й день течения СOVID-19 возникли сильная боль в шее, а через несколько часов — слабость в стопах, которая затем распространилась на проксимальные отделы ног и на руки. Развились выраженный тетрапарез (до плегии в ногах) с арефлексией, проводниковые нарушения чувствительности с уровня Th4, расстройства функции тазовых органов. Патологические пирамидные знаки отсутствовали. Признаков дыхательных нарушений и системных воспалительных проявлений COVID-19 не было.

Магнитно-резонансная томография спинного мозга выявила патологический очаг шейно-грудной локализации, по характеристикам соответствовавший поперечному продольно распространенному миелиту. Наряду с миелитом, была диагностирована острая моторная аксональная полиневропатия, в пользу которой свидетельствовали сухожильная арефлексия, восходящий тип распространения двигательных расстройств, наличие белково-клеточной диссоциации в цереброспинальной жидкости и данные электронейромиографии. Развитие миелита и СГБ у пациента, вероятно, было вызвано дизиммунными нарушениями, спровоцированными COVID-19. Иные возможные причины поражения спинного мозга и полиневропатии были исключены. Терапия включала внутривенное введение иммуноглобулина и также, с учетом наличия миелита, глюкокортикостероидов.

Через 4 мес. двигательные функции у пациента восстановились незначительно.

We report a case of transverse myelitis and Guillain–Barre syndrome (GBS) overlap in the 42-year-old patient with moderate course of Coronavirus disease 2019 (СOVID-19). Nasopharyngeal SARS-CoV 2 RT-PCR was positive. Severe neck pain developed in this patient on the 5-th day of СOVID-19. A few hours later weakness in the feet arised and then spread to the thighs and arms.

Quadriparesis, arefl exia in all limbs, sensory loss below the level of T4 and bladder/bowel dysfunction were present. Pyramidal signs were negative. There was no increase of COVID-19 severity at the time of neurological signs development.

Magnetic resonance imaging of the spinal cord showed the focal lesion in the C2-T1 segments, which was consistent with the features of longitudinally extensive transverse myelitis.

Along with the myelitis, acute motor axonal polyneuropathy was diagnosed. This diagnosis of GBS was supported by ascending weakness with arefl exia, albumin-cytological dissociation in cerebrospinal fl uid and the data of neuroelectrophysiological examination.

We proposed that both myelitis and GBS had disimmune nature associated with COVID-19. The other possible causes of damage to the spinal cord and peripheral nervous system were excluded.

Immunotherapy with high dose of intravenous immunoglobulins was administered. Steroids also were used taking into account the myelitis.

At the follow up in 4 months the motor functions were found to be improved nonsignifi cantly, the patient was still severe disabled.

коронавирусная инфекцияпоперечный миелитострая моторная аксональная полиневропатияперекрестный синдромпоперечный синдромсиндром Гийена–БарреСOVID-19acute motor axonal polyneuropathycoronavirus diseaseСOVID-19Guillain–Barre syndrome transverse myelitisoverlap syndromeReferencesZubair A.S., McAlpine L.S., Gardin T., Farhadian S., Kuruvilla D.E., Spudich S. Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019: A Review. JAMA Neurol. 2020;77(8):1018–1027. https://doi.org/10.1001/jamaneurol.2020.2065Zubair A.S., McAlpine L.S., Gardin T., Farhadian S., Kuruvilla D.E., Spudich S. Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019: A Review. JAMA Neurol. 2020;77(8):1018–1027. https://doi.org/10.1001/jamaneurol.2020.2065Román G.C., Gracia F., Torres A., Palacios A., Gracia K., Harris D. Acute Transverse Myelitis (ATM):Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 PostVaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222). Front Immunol. 2021;12:653786. https://doi.org/10.3389/fi mmu.2021.653786Román G.C., Gracia F., Torres A., Palacios A., Gracia K., Harris D. Acute Transverse Myelitis (ATM):Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 PostVaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222). Front Immunol. 2021;12:653786. https://doi.org/10.3389/fi mmu.2021.653786Schulte E.C., Hauer L., Kunz A.B., Sellner J. Systematic Review of Cases of Acute Myelitis in Individuals with COVID-19. Eur J Neurol. 2021 Jun 1. https://doi.org/10.1111/ene.14952Schulte E.C., Hauer L., Kunz A.B., Sellner J. Systematic Review of Cases of Acute Myelitis in Individuals with COVID-19. Eur J Neurol. 2021 Jun 1. https://doi.org/10.1111/ene.14952Abu-Rumeileh S., Abdelhak A., Foschi M., Tumani H., Otto M. Guillain–Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol. 2021;268(4):1133–1170. https://doi.org/10.1007/s00415-020- 10124-xAbu-Rumeileh S., Abdelhak A., Foschi M., Tumani H., Otto M. Guillain–Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol. 2021;268(4):1133–1170. https://doi.org/10.1007/s00415-020- 10124-xGoh C., Desmond P.M., Phal P.M. MRI in transverse myelitis. J Magn Reson Imaging. 2014;40(6):1267–79. https://doi. org/10.1002/jmri.24563Goh C., Desmond P.M., Phal P.M. MRI in transverse myelitis. J Magn Reson Imaging. 2014;40(6):1267–79. https://doi. org/10.1002/jmri.24563Пирадов М.А., Супонева Н.А., Гришина Д.А. Полинейропатии: алгоритмы диагностики и лечения. Москва: Горячая линия-Телеком, 2019:248 с.Piradov M.A., Suponeva N.A., Grishina D.A. Polyneuropathies: algorithms of diagnostic and treatment. Moscow: Goryachaya liniya-Telekom, 2019:248 p. (In Russ.).Maideniuc C, Memon AB. Acute necrotizing myelitis and acute motor axonal neuropathy in a COVID-19 patient. J Neurol. 2020;Aug9:1–3. https://doi.org/10.1007/s00415-020-10145-6Maideniuc C, Memon AB. Acute necrotizing myelitis and acute motor axonal neuropathy in a COVID-19 patient. J Neurol. 2020;Aug9:1–3. https://doi.org/10.1007/s00415-020-10145-6Valiuddin H., Skwirsk B., Paz-Arabo P. Acute transverse myelitis associated with SARS-CoV-2: A Case-Report. Brain Behav Immun Health. 2020;5:100091. https://doi.org/10.1016/j. bbih.2020.100091Valiuddin H., Skwirsk B., Paz-Arabo P. Acute transverse myelitis associated with SARS-CoV-2: A Case-Report. Brain Behav Immun Health. 2020;5:100091. https://doi.org/10.1016/j. bbih.2020.100091Masuccio F.G., Barra M., Claudio G., Claudio S. A rare case of acute motor axonal neuropathy and myelitis related to SARSCoV-2 infection. J Neurol. 2020;Sep 17:1–4. https://doi. org/10.1007/s00415-020-10219-5Masuccio F.G., Barra M., Claudio G., Claudio S. A rare case of acute motor axonal neuropathy and myelitis related to SARSCoV-2 infection. J Neurol. 2020;Sep 17:1–4. https://doi. org/10.1007/s00415-020-10219-5Guo F., Zhang Y.B. Clinical features and prognosis of patients with Guillain–Barré and acute transverse myelitis overlap syndrome. Clin Neurol Neurosurg. 2019;181:127–132. https://doi. org/10.1016/j.clineuro.2019.04.014Guo F., Zhang Y.B. Clinical features and prognosis of patients with Guillain–Barré and acute transverse myelitis overlap syndrome. Clin Neurol Neurosurg. 2019;181:127–132. https://doi. org/10.1016/j.clineuro.2019.04.014Stoian A., Motataianu A., Bajko Z., Balasa A. Guillain–Barré and Acute Transverse Myelitis Overlap Syndrome Following Obstetric Surgery. J Crit Care Med (Targu Mures). 2020;6(1):74–79. https://doi.org/10.2478/jccm-2020-0008Stoian A., Motataianu A., Bajko Z., Balasa A. Guillain–Barré and Acute Transverse Myelitis Overlap Syndrome Following Obstetric Surgery. J Crit Care Med (Targu Mures). 2020;6(1):74–79. https://doi.org/10.2478/jccm-2020-0008Муртазина А.Ф., Наумова Е.С., Никитин С.С., Борискина Л.М., Лагутин А.В. Стволовой энцефалит Бикерстаффа, острый поперечный миелит и острая моторная аксональная нейропатия: сложности диагностики и лечения пациентов с перекрестными синдромами. Клиническое наблюдение. Нервно-мышечные болезни. 2017;7(3):56–62. https://doi.org/10.17650/2222-8721-2017-7-3-56-62Murtazina A.F., Naumova E.S., Nikitin S.S., Boriskina L.M., Lagutin A.V. Bickerstaff brainstem encephalitis, acute transverse myelitis, and acute motor axonal neuropathy: diagnostic and treatment challenges in patients with concomitant syndromes. Clinical observation. Neuromuscular Diseases. 2017;7(3):56–62. (In Russ.). https://doi.org/10.17650/2222-8721-2017-7-3-56-62Fokke C., van den Berg B., Drenthen J., Walgaard C., van Doorn P.A., Jacobs B.C. Diagnosis of Guillain–Barré syndrome and validation of Brighton criteria. Brain. 2014;137(Pt 1):33–43. https://doi.org/10.1093/brain/awt285Fokke C., van den Berg B., Drenthen J., Walgaard C., van Doorn P.A., Jacobs B.C. Diagnosis of Guillain–Barré syndrome and validation of Brighton criteria. Brain. 2014;137(Pt 1):33–43. https://doi.org/10.1093/brain/awt285Hadden R.D., Cornblath D.R., Hughes R.A., Zielasek J., Hartung H.P., Toyka K.V., Swan A.V. Electrophysiological classifi cation of Guillain–Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain–Barré Syndrome Trial Group. Ann Neurol. 1998;44(5):780–8. https://doi. org/10.1002/ana.410440512Hadden R.D., Cornblath D.R., Hughes R.A., Zielasek J., Hartung H.P., Toyka K.V., Swan A.V. Electrophysiological classifi cation of Guillain–Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain–Barré Syndrome Trial Group. Ann Neurol. 1998;44(5):780–8. https://doi. org/10.1002/ana.410440512Srivastava A., Kundu B.K., Singh D.K. Concomitant Guillain– Barre Syndrome and Transverse Myelitis as Initial Neuropsychiatric Manifestation in a Case of Lupus: A Diagnostic Quandary. Case Rep Rheumatol. 2016;2016:5827860. https://doi. org/10.1155/2016/5827860Srivastava A., Kundu B.K., Singh D.K. Concomitant Guillain– Barre Syndrome and Transverse Myelitis as Initial Neuropsychiatric Manifestation in a Case of Lupus: A Diagnostic Quandary. Case Rep Rheumatol. 2016;2016:5827860. https://doi. org/10.1155/2016/5827860Ugurlu S., Saygin C., Uzunaslan D., Tascilar K., Ince B., Saip S. Concomitant transverse myelitis and guillain-barre syndrome after adalimumab therapy in a case with ankylosing spondylitis. Annals of the Rheumatic Diseases. 2014;73:40–4. http://dx.doi. org/10.1136/annrheumdis-2013-205124.92Ugurlu S., Saygin C., Uzunaslan D., Tascilar K., Ince B., Saip S. Concomitant transverse myelitis and guillain-barre syndrome after adalimumab therapy in a case with ankylosing spondylitis. Annals of the Rheumatic Diseases. 2014;73:40–4. http://dx.doi. org/10.1136/annrheumdis-2013-205124.92Hamdy S.M., Abdel-Naseer M., Shehata H.S., Shalaby N.M., Hassan A., Elmazny A., Shaker E., Nada M.A.F., Ahmed S.M., Hegazy M.I., Mourad H.S., Abdelalim A., Magdy R., Othman A.S., Mekkawy D.A., Kishk N.A. Management Strategies of Patients with Neuromyelitis Optica Spectrum Disorder During the COVID-19 Pandemic Era. Ther Clin Risk Manag. 2020;16:759– 767. https://doi.org/10.2147/TCRM.S261753Hamdy S.M., Abdel-Naseer M., Shehata H.S., Shalaby N.M., Hassan A., Elmazny A., Shaker E., Nada M.A.F., Ahmed S.M., Hegazy M.I., Mourad H.S., Abdelalim A., Magdy R., Othman A.S., Mekkawy D.A., Kishk N.A. Management Strategies of Patients with Neuromyelitis Optica Spectrum Disorder During the COVID-19 Pandemic Era. Ther Clin Risk Manag. 2020;16:759– 767. https://doi.org/10.2147/TCRM.S261753Hughes R.A., Brassington R., Gunn A.A., van Doorn P.A. Corticosteroids for Guillain–Barré syndrome. Cochrane Database Syst Rev. 2016;10(10):CD001446. https://doi.org/10.1002/14651858. CD001446.pub5.Hughes R.A., Brassington R., Gunn A.A., van Doorn P.A. Corticosteroids for Guillain–Barré syndrome. Cochrane Database Syst Rev. 2016;10(10):CD001446. https://doi.org/10.1002/14651858. CD001446.pub5.

The authors declare that there are no conflicts of interest present.