Guillain-Barré syndrome after COVID-19 vaccination

Hundreds of presumptive cases of Guillain-Barré syndrome (GBS) were identified following adenovirus COVID-19 vaccines. Dozens of cases have been reported for mRNA vaccines.

An 80-year-old male patient presented to emergency room with chief complaints of progressive, ascending bilateral lower extremity paresthesia, and weakness following COVID-19 (Moderna) vaccine. He received his first dose of Moderna vaccine about three months after recovery from COVID-19. Soon after vaccination he noticed bilateral lower extremity paresthesia (tingling and numbness), which was followed by progressive bilateral lower limb distal weakness, beginning at his feet and then ascending to involve his legs, knees, and hips. He was unable to maintain balance and started having multiple falls prompting him to start using a walker for ambulation. He then received the second dose of his vaccine in February 2021. The next morning, he was unable to get out of his bed due to severe bilateral lower extremity weakness, and he therefore presented to the emergency room.


The patient's past medical history was notable for COVID-19 infection the previous year, from which he had an uneventful recovery, chronic lymphocytic leukemia (CLL) without the end organ involvement for which he had not received any treatment, degenerative disease of lumbar spine, remote history of TIA, hypertension, and hyperlipidemia. The patient denied recent trauma, exposure to drugs / toxins, recent infection, auto-immune disease, family history of hereditary neuropathy or personal history of smoking, alcohol, and drug dependence. 

Toward the end of his 5 days of IVIG therapy, the patient noted significant improvement in bilateral lower extremity strength and began to ambulate with help from physical therapy.

REFERENCE

Anjum Z, Iyer C, Naz S, et al. Guillain-Barré syndrome after mRNA-1273 (Moderna) COVID-19 vaccination: A case report. Clin Case Rep. 2022;10:e05733. doi:10.1002/ccr3.5733

Guillain‐Barré syndrome after mRNA‐1273 (Moderna) COVID‐19 vaccination: A case report - Anjum - 2022 - Clinical Case Reports - Wiley Online Library

See also

Hanson KE, Goddard K, Lewis N, et al. Guillain-Barré syndrome after COVID-19 vaccination in the vaccine safety datalink. medRxiv. 2021. http://medrxiv.org/content/early/ 2021/12/05/2021.12.03.21266419.abstract 19.

Woo EJ, Mba-Jonas A, Dimova RB, Alimchandani M, Zinderman CE, Nair N. Association of receipt of the Ad26. COV2.S COVID-19 vaccine with presumptive Guillain-Barré syndrome, February-July 2021. JAMA. 2021;326(16):1606-1613. 20.

Maramattom BV, Krishnan P, Paul R, et al. Guillain-Barré syndrome following ChAdOx1-S/nCoV-19 vaccine. Ann Neurol. 2021;90(2):312-314

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