Guillain-Barre Syndrome in a Patient With Asymptomatic Coronavirus Disease 2019 Infection and Major Depressive Disorder

Coronavirus disease 2019 (COVID-19) has had a devastating effect on all aspects of society, including the economy, healthcare, and educational institutions. One underrecognized effect of the pandemic is the decline of mental health in our communities. Studies have shown that pandemic-related stress is associated with increased depression and anxiety. In addition to worsening mental health, COVID-19 infection has been shown to have neurological manifestations. We report the case of a 56-year-old woman with a history of major depressive disorder and alcohol use with no recent history of infection or vaccination who presented with hand and foot paresthesias over the past six weeks, 30 lb weight loss, dysphoric mood, and acutely progressive ambulatory dysfunction over the past two weeks, for which she required assistance to ambulate. Psychiatric evaluation was significant for depressive symptoms. On neurologic examination, she had decreased deep tendon reflexes and ataxic, jerky gait. She was found to be positive for COVID-19. Labs and findings demonstrated albuminocytologic dissociation which suggests presumptive diagnosis of Guillain-Barre syndrome, prompting treatment with intravenous immunoglobulin for five days. She was noted to be deficient in zinc, folate, copper, and borderline B-12, as well as mild hyponatremia, hypokalemia, and hypomagnesemia likely secondary to depression-induced loss of appetite and alcohol use disorder. Guillain-Barre is a severe and debilitating outcome that must be considered when evaluating neuromuscular weakness in the setting of COVID-19, even in asymptomatic patients. Our case highlights the multifactorial intersection between Guillain-Barre syndrome, COVID-19, and concomitant mental health and alcohol use disorder.