{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T07:54:55Z","timestamp":1770278095250,"version":"3.49.0"},"reference-count":26,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,11,19]],"date-time":"2020-11-19T00:00:00Z","timestamp":1605744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["3U01AI122285-05S1"],"award-info":[{"award-number":["3U01AI122285-05S1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["3UL1TR003017-02S1"],"award-info":[{"award-number":["3UL1TR003017-02S1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Coronavirus 2019 (COVID-19) has been reported to trigger Guillain\u2013Barr\u00e9 syndrome (GBS). While uncommon, recurrent GBS (rGBS) episodes, triggered by antecedent viral infections, have been reported in a small proportion of GBS patients, here we describe a patient with a recurrent case of GBS, occurring secondary to COVID-19 infection. Before this patient\u2019s episode, he had two prior GBS flares, each precipitated by a viral infection followed by complete recovery besides intermittent paresthesias. We also consider the nosology of this illness in the spectrum of rGBS and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), with their differing natural histories, prognosis, and therapeutic approaches. For patients who have a history of inflammatory demyelinating polyradiculopathies who develop COVID-19, we recommend close observation for neurologic symptoms over the next days and weeks.<\/jats:p>","DOI":"10.3390\/pathogens9110965","type":"journal-article","created":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T02:09:07Z","timestamp":1605838147000},"page":"965","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["COVID-19 as a Trigger of Recurrent Guillain\u2013Barr\u00e9 Syndrome"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8703-5828","authenticated-orcid":false,"given":"Erin P.","family":"McDonnell","sequence":"first","affiliation":[{"name":"Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7085-4031","authenticated-orcid":false,"given":"Nicole J.","family":"Altomare","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yesha H.","family":"Parekh","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ram C.","family":"Gowda","sequence":"additional","affiliation":[{"name":"Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Payal D.","family":"Parikh","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3258-3760","authenticated-orcid":false,"given":"Mark H.","family":"Lazar","sequence":"additional","affiliation":[{"name":"Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2447-2443","authenticated-orcid":false,"given":"Martin J.","family":"Blaser","sequence":"additional","affiliation":[{"name":"Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, NJ 08854, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e00771","DOI":"10.1016\/j.idcr.2020.e00771","article-title":"Guillain-Barr\u00e9 Syndrome associated with SARS-CoV-2 infection","volume":"20","author":"Virani","year":"2020","journal-title":"IDCases"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1002\/mus.27024","article-title":"COVID-19\u2013associated Guillain-Barr\u00e9 syndrome: The early pandemic experience","volume":"62","author":"Caress","year":"2020","journal-title":"Muscle Nerve"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1001\/jamaneurol.2020.1127","article-title":"Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China","volume":"77","author":"Mao","year":"2020","journal-title":"JAMA Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2378","DOI":"10.1111\/ene.14473","article-title":"Miller-Fisher syndrome after COVID-19: Neurochemical markers as an early sign of nervous system involvement","volume":"27","author":"Senel","year":"2020","journal-title":"Eur. J. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"117106","DOI":"10.1016\/j.jns.2020.117106","article-title":"Exacerbation of chronic inflammatory demyelinating polyneuropathy in concomitance with COVID-19","volume":"418","author":"Garibashvili","year":"2020","journal-title":"J. Neurol. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/ane.13266","article-title":"Neurological Manifestations of COVID-19: A systematic review and current update","volume":"142","author":"Whittaker","year":"2020","journal-title":"Acta Neurol. Scand."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1093\/brain\/awt285","article-title":"Diagnosis of Guillain-Barre syndrome and validation of Brighton criteria","volume":"137","author":"Fokke","year":"2014","journal-title":"Brain"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1093\/brain\/115.4.1093","article-title":"Recurrent Guillain-Barr\u00e9 syndrome. Clinical and laboratory features","volume":"115","author":"Feasby","year":"1992","journal-title":"Brain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1136\/jnnp.2008.156463","article-title":"Recurrent Guillain\u2013Barr\u00e9 syndrome","volume":"80","author":"Kuitwaard","year":"2009","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1136\/jnnp.2008.160069","article-title":"Deterioration after Guillain-Barre syndrome: Recurrence, treatment-related fluctuation or CIDP?","volume":"80","author":"Hadden","year":"2008","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.mayocp.2018.03.026","article-title":"History, Diagnosis, and Management of Chronic Inflammatory Demyelinating Polyradiculoneuropathy","volume":"93","author":"Dyck","year":"2018","journal-title":"Mayo Clin. Proc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1212\/01.WNL.0000034172.47882.20","article-title":"Dispersion of the distal compound muscle action potential as a diagnostic criterion for chronic inflammatory demyelinating polyneuropathy","volume":"59","author":"Thaisetthawatkul","year":"2002","journal-title":"Neurology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1529-8027.2010.00245.x","article-title":"European Federation of Neurological Societies\/Peripheral Nerve Society Guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society\u2014First Revision","volume":"15","author":"Hadden","year":"2010","journal-title":"J. Peripher. Nerv. Syst."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/0022-510X(77)90205-2","article-title":"Aids to the examination of the peripheral nervous system:(Medical research council memorandum, no. 45, superseding war memorandum no. 7)","volume":"33","author":"Matthews","year":"1977","journal-title":"J. Neurol. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1097\/00019052-199810000-00013","article-title":"Guillain\u2013Barr\u00e9 syndrome, CIDP and other chronic immune-mediated neuropathies","volume":"11","author":"Hartung","year":"1998","journal-title":"Curr. Opin. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/S1474-4422(20)30221-0","article-title":"Neurological associations of COVID-19","volume":"19","author":"Ellul","year":"2020","journal-title":"Lancet Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e850","DOI":"10.1212\/NXI.0000000000000850","article-title":"Guillain-Barr\u00e9 syndrome related to SARS-CoV-2 infection","volume":"7","author":"Toscano","year":"2020","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2723","DOI":"10.2169\/internalmedicine.0588-17","article-title":"Pyrexia-associated Relapse in Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Case Report","volume":"57","author":"Ueda","year":"2018","journal-title":"Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1002\/ana.410270707","article-title":"Assessment of current diagnostic criteria for Guillain-Barr\u00e9 syndrome","volume":"27","author":"Asbury","year":"1990","journal-title":"Ann. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1016\/j.jdiacomp.2016.05.007","article-title":"The dilemma of diabetes in chronic inflammatory demyelinating polyneuropathy","volume":"30","author":"Bril","year":"2016","journal-title":"J. Diabetes Complicat."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1177\/1932296820924469","article-title":"Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States","volume":"14","author":"Bode","year":"2020","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"21","DOI":"10.4081\/ni.2017.7032","article-title":"Are Cerebrospinal Fluid Protein Levels and Plasma Neutrophil\/Lymphocyte Ratio Associated with Prognosis of Guillain Barr\u00e9 Syndrome?","volume":"9","author":"Sahin","year":"2017","journal-title":"Neurol. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1002\/(SICI)1097-4598(200001)23:1<37::AID-MUS5>3.0.CO;2-9","article-title":"Influence of diabetes mellitus on chronic inflammatory demyelinating polyneuropathy","volume":"23","author":"Gorson","year":"2000","journal-title":"Muscle Nerve"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.neucli.2004.01.004","article-title":"Atypical electrophysiologic findings in chronic inflammatory demyelinating polyneuropathy (CIDP)\u2014Diagnosis confirmed by nerve biopsy","volume":"34","author":"Boukhris","year":"2004","journal-title":"Neurophysiol. Clin. Clin. Neurophysiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1212\/WNL.0b013e3181e07d14","article-title":"Distinguishing acute-onset CIDP from fluctuating Guillain-Barre syndrome: A prospective study","volume":"74","author":"Ruts","year":"2010","journal-title":"Neurology"},{"key":"ref_26","first-page":"249","article-title":"Recurrent Guillain Barre\u2019 Syndrome: A clinical, electrophysiological and morphological study","volume":"43","author":"Taly","year":"1995","journal-title":"J. Assoc. Physicians India"}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/9\/11\/965\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:34:37Z","timestamp":1760178877000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/9\/11\/965"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,19]]},"references-count":26,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["pathogens9110965"],"URL":"https:\/\/doi.org\/10.3390\/pathogens9110965","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,19]]}}}