Chronic Inflammatory Demyelinating Polyneuropathy After COVID-19 Vaccination

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune neurological disorder that affects the peripheral nervous system. Unlike Guillain-BarrĂ© syndrome (GBS) that develops rapidly and reaches its peak within a few weeks, CIDP is a chronic condition that develops more slowly and can last for months or even years. It is characterized by chronic inflammation and damage to the myelin sheath that covers and protects the nerves, leading to symptoms such as weakness, numbness, and tingling in the arms and legs. CIDP is estimated to affect about 1 to 2 people per 100,000 population per year, and it can occur at any age, although it is more common in middle-aged and older adults. Left untreated, 30% of CIDP patients will progress to wheelchair dependence. 

A previously healthy72-year-old man presented with a progressive tingling sensation and weakness below both knees for two weeks that started two weeks after vaccination with the 3rd dose of mRNA-1273. As the symptoms progressed, he could not walk independently and had difficulty using chopsticks. He had no underlying diseases or recent infection history. His first and the second doses of the COVID-19 vaccine were BNT162b2 and caused no adverse effects. Neurological examinations identified distal dominant limb weakness, deficits of light touch and vibration sensation in the bilateral fingertips and below both knees, and areflexia in all four limbs. Nerve conduction studies (NCS) revealed demyelinating polyneuropathy. Limb weakness and sensory deficits improved after intravenous immunoglobulin (IVIg) treatment, and subsequent NCS showed improved demyelinating polyneuropathy. Approximately ten weeks after the onset, he experienced worsened tingling sensation on the feet with gait disturbance. Tests showed aggravated demyelinating polyneuropathy. IVIg and azathioprine were administered with oral prednisolone, which improved his symptoms, except for the mild gait disturbance. The case met the clinical criteria for typical CIDP.

A 50-year-old man received the first dose of the Ad26.COV2.S vaccine against COVID-19 and experienced a tingling sensation in both legs after a week and gait disturbance three weeks after that. He had hypertension and no recent history of infection. Neurological examinations identified vibration sensation deficits below the ankles, bilateral distal dominant motor weakness on the lower extremities, areflexia, and positive results in the Romberg test. Blood and urine tests as well as brain MRI revealed no abnormalities. CIDP was suspected because of the progressive symptoms lasting more than four weeks (his waveform of Nerve Conduction Studies is shown in the Figure). High-dose oral prednisolone (60 mg/day) was started but led to severe tremors and palpitations without improvement. IVIg was administered for two days along with reduced dosage of oral prednisolone and azathioprine. His symptoms improved.


REFERENCE

Kim S, Lee EK, Sohn E. Two Case Reports of Chronic Inflammatory Demyelinating Polyneuropathy After COVID-19 Vaccination. J Korean Med Sci. 2023 Feb 27;38(8):e57. doi: 10.3346/jkms.2023.38.e57. PMID: 36852853; PMCID: PMC9970789.

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