Moving On Up: A Case Study of HIV and COVID-Induced Guillain-Barre Syndrome

COVID and HIV are both common diseases, with COVID affecting an estimated 775 million and HIV affecting 39 million people worldwide. Guillain-Barre is a rare but feared complication of immune stimulation in which the body generates autoantibodies against gangliosides, found in the nodes of Ranvier, in the myelin, and in the ganglia; causing ascending paralysis. A mid-30s man with HIV maintained on Genvoya presented to the Jefferson Health New Jersey Early Intervention Program clinic with fatigue, fever, cough, and congestion and tested positive for SARS-CoV-2 on the following day. Two weeks later, he presented to the emergency department complaining of numbness, paresthesias, weakness, and abnormal gait of the left lower extremity. Imaging demonstrated vertebral artery stenosis and foraminal stenosis, but no acute cause of nerve impingement. Other meningitis and encephalitis testing was negative, but CSF contained red blood cells. Numbness continued to ascend to the torso and ganglioside testing was ordered while a 5-day course of intravenous immunoglobulin was started. His symptoms began improving one week after finishing treatment and EMG was normal 9 weeks later. At his last visit, he endorsed residual altered sensation in the perirectal area and left thigh, but motor function was intact. Close support from his husband and community was vital in early identification of key symptoms and entry to treatment. Guillain-Barre should be considered in patients with fulminant symptoms even in the setting of HIV- and HAART-induced peripheral neuropathy or spinal stenosis.