ritonavir and Guillain-Barre-Syndrome

This case series describes three patients affected by severe acute respiratory syndrome coronavirus 2, who developed polyradiculoneuritis as a probable neurological complication of coronavirus disease 2019 (COVID-19). A diagnosis of Guillain Barré syndrome was made on the basis of clinical symptoms, cerebrospinal fluid analysis, and electroneurography. In all of them, the therapeutic approach included the administration of intravenous immunoglobulin (0.4 gr/kg for 5 days), which resulted in the improvement of neurological symptoms. Clinical neurophysiology revealed the presence of conduction block, absence of F waves, and in two cases, a significant decrease in amplitude of compound motor action potential cMAP. Due to the potential role of inflammation on symptoms development and prognosis, interleukin-6 (IL-6) and IL-8 levels were measured in serum and cerebrospinal fluid during the acute phase, while only serum was tested after recovery. Both IL-6 and IL-8 were found increased during the acute phase, both in the serum and cerebrospinal fluid, whereas 4 months after admission (at complete recovery), only IL-8 remained elevated in the serum. These results confirm the inflammatory response that might be linked to peripheral nervous system complications and encourage the use of IL-6 and IL-8 as prognostic biomarkers in COVID-19.

Topics: Action Potentials; Acute Disease; Aged; Anti-Bacterial Agents; Biomarkers; Convalescence; COVID-19; COVID-19 Drug Treatment; Darunavir; Drug Combinations; Guillain-Barre Syndrome; Humans; Hydroxychloroquine; Immunoglobulins, Intravenous; Interleukin-6; Interleukin-8; Lopinavir; Male; Neural Conduction; Peripheral Nervous System; Prognosis; Respiratory Insufficiency; Ritonavir; SARS-CoV-2