Case presentation:
A 41-year-old female with a pre-existed medical history of type 2
diabetes has arrived at the emergency unit of Royal Care Hospital in
Khartoum state, Sudan presented with fever, chills, headache, productive
cough, diarrhoea, lower limb weakness, and back pain.
The weakness progressed to the upper limbs within 24 hours. She reported
that, in the previous seven days, she experienced fatigue, headache,
fever and chills, and she received paracetamol. She had a normal pulse
rate (76/min), respiratory rate (17/min), blood pressure (90/50), and
temperature (39°C). Neurological examinations showed generalized
areflexia and down-going plantar reflexes. The muscle power assessment
scale (MRCS) was 0/5 in the upper limbs and the lower limbs. A computed
tomography scan of the thorax revealed bi-basilar consolidation and
patchy peripheral ground-glass opacities in line with classic COVID-19
infection. Her nasopharyngeal swab was positive for SARS Cov-2 with
real-time polymerase chain reaction assay (RT-PCR). Other viral
infections associated with developing GBS were excluded using multiple
RT-PCR assays. Similarly for the associated parasitic infections, they
were excluded except for malaria which was positive. Her full blood
count revealed leucopenia, high C-reactive protein (40mg/L), blood film
showed asexual stage trophozoites of Plasmodium falciparum and
ICT was also positive (Figure 1). The CSF showed E-protein without
cells. The electromyography (EMG), on the 2nd day
after admission, showed a demyelinating pattern.
For the treatment, the patient received intravenous immunoglobulin
(IVIG) (0.4 g/kg/day for five days), and a paracetamol infusion for the
back pain. For the malaria infection, the patient received
artemether/lumefantrine four tablets (20 mg artemether; 120 mg
lumefantrine per tablet) orally (PO) as an initial dose, followed by
four tablets PO 8 hours after the initial dose, then four tablets PO
twice daily (morning and evening) for two days for a total course of 24
tablets. She responded well after three days. Upper and lower limbs
showed an improved power grade (3/5).