A 41-year-old lady presented to ER with facial weakness, inability to close right eye with drooling of saliva. She has no significant past history apart from being diagnosed with COVID-19 one month ago. She was diagnosed as bell’s palsy and started on steroid and acyclovir. A couple of days later she was presented to OPD with generalized weakness. On examination, she had lower motor neuron type facial palsy and 12^th nerve palsy with fasciculation and deviation of tongue to right side. There was loss of sensation to pain and temperature in both lower limbs. Also, loss of vibration and position sense. Power in both upper and lower limbs was 3/5. On deep tendon reflex examination there was generalized areflexia. There was worsening in the power over subsequent period. Her CSF analysis and nerve conduction velocity was consistent with GBS. Patient was started on IV immunoglobulin, there was a remarkable improvement in 2 weeks time with complete recovery of motor and sensory system. This patient had GBS with variant of multiple cranial neuropathies. It is rare post COVID-19 complication.

GBS is infrequent complication of COVID-19. Five cases have been identified among 1200 patient admitted in three north Italian hospitals 4. Most patients with GBS with COVID-19 presented with progressive ascending limb weakness over one to four days. The onset of weakness due to post viral illness is about 5 to 10 days which is similar to its onset compared to other viral illness associated with GBS. The diagnosis of GBS should be considered in setting of progressive limb weakness and also chest findings are not commensurate with respiratory insufficiency 4. IV immunoglobulin is as effective as plasmapheresis in the treatment of GBS 1. IV immunoglobulin is given at dose of 0.4mg/kg for 5 days. The side effects include rash, aseptic meningitis, acute renal failure and rarely hyperviscocity syndrome leading to stroke. IgA deficiency can lead to anaphylaxis 5.