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-Barré 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.

Comments

Post a Comment

Popular posts from this blog

A New Onset of Ulcerative Colitis post-2nd-breakthrough-COVID-19

Image
A 21-year-old non-smoking Caucasian male with a history of acute pancreatitis but no other medical issues or family history had two doses of the BNT162b2 mRNA COVID-19 vaccine.  Four months after the second dose he had his first episode of COVID-19. Although not hypoxic, he felt pretty unwell for a week, with a severe cough, fever, generalized body ache, headache, and loss of taste. He received the third dose of the vaccine two months after recovering from COVID. Nine months after the third dose, he had the second episode of COVID-19, during which he was mildly unwell for three days, recovered, and did not require any anti-viral medication or antibiotics. One week post the second episode of COVID-19, he developed diarrhea and abdominal pain. It then progressed to bloody diarrhea. Ulcerative colitis was diagnosed based on his clinical symptoms, biopsy changes, and the exclusion of other causes.  There are ten published case reports about the newly diagnosed ulcerative colitis associate
Read more

COVID in May

Image
Concerns about a potential resurgence of COVID-19 are mounting as summer 2024 approaches.  This is driven by several indicators, including social media posts, healthcare data, and wastewater surveillance across different regions. Our study findings corroborate this trend.  While many forecasters anticipate a surge, others expect a gradual increase through the end of May, and then a decline again around early June. Reports from social media suggest emerging clusters of COVID-19 in Texas, several Canadian provinces, the UK, and on cruises in northern regions such as a Norwegian cruise to Alaska.  Data from Alberta's Respiratory virus dashboard   (total weekly laboratory-confirmed COVID-19 cases) and wastewater surveillance in Calgary indicate an uptick in COVID-19 cases starting April 2024. The most recent statistics from Alberta Health reveal a significant increase in hospitalizations due to COVID-19, with 114 individuals currently hospitalized—an increase of more than 20% over two
Read more

Chronic SARS-CoV-2 Shedding

Image
Chronic viral shedding, a condition where the virus continues to be released from an individual's body long after the initial infection, has been observed in many infectious diseases, including COVID-19.  In such cases, individuals may remain asymptomatic or experience only mild symptoms while the virus persists. It remains detectable in repeated tests over an extended period and can still infect others even in nasal swab is negative (which happens quite often ). This was evident in our study.    Recent research by Conway et al. (2024) highlights the possibility of chronic SARS-CoV-2 infection, extending over several months and potentially years. Other studies have documented prolonged asymptomatic infections and extended viral shedding in moderate to severe beyond hospital discharge. Analysis of sequencing data on UK samples taken between 2 November 2020 and 15 August 2022 lead to estimates that 0.1–0.5% of infections may become persistent with typically rebounding high viral load
Read more