To describe a case of a 58-year-old patient who presented to the hospital with Acute Inflammatory demyelinating Polyneuropathy (AIDP) as the first symptom of SARS COVID-19 infection without other classic manifestations of COVID-19 infection.

COVID-19 associated Guillain Barre syndrome is now widely reported. In our literature review, the majority of GBS patients had preceding respiratory symptoms of COVID-19 but our patient had no other systemic involvement, and his symptoms started noticeably within a short duration of exposure.

 Case report.

58-year-old male patient presented to the hospital with bilateral lower extremity weakness, facial diplegia and dysphagia. Patient was tested positive for COVID-19 infection three days prior to the symptom onset due to a work-related exposure. He denied having any flu-like symptoms except generalized weakness. Patient reported progressive lower leg weakness started three days back with associated numbness and radicular pain up to T4 level. On examination, the patient had facial diplegia, areflexia and bilateral lower limb ataxia with the strength of about 3/5. CSF analysis showed albuminocytological dissociation. MRI brain and spine showed faint enhancement of lower lumbar roots. GQ1b antibody was positive on Ganglioside panel. With the clinical criteria and laboratory evidence, patient was diagnosed with AIDP. Patient was started on IVIG but due to lack of improvement after four doses patient was switched to therapeutic plasma exchange. He underwent a total of 7 sessions of plasmapheresis with improvement of motor and sensory symptoms.

Although most cases were symptomatic for COVID-19, patients without respiratory or systemic symptoms raises a significant healthcare concern, namely the importance of SARS COVID-19 testing in all patients with suspected GBS during this global pandemic. Early diagnosis of COVID-19 associated GBS is also essential for rapid case isolation