Polyradiculoneuropathy after breakthrough COVID-19

In late July 2021, a 67-year-old woman vaccinated with Sinopharm COVID-19 vaccine (inactivated virus) presented a unique and challenging medical case that underscores potential neurological consequences of both infection and vaccination. 

The patient's journey began with the onset of common COVID-19 symptoms: fever, myalgia, mild dyspnea, headache, and a non-productive cough. She had no pre-existing medical conditions. Upon her initial evaluation, her vital signs were within a relatively stable range, with the exception of a slightly decreased oxygen saturation (SpO2) of 91%. Physical examination did not reveal any significant findings.

Her positive SARS-CoV-2 polymerase chain reaction test prompted further investigation, given the mild dyspnea and decreased SpO2. A chest computed tomography scan revealed peripheral consolidation and ground glass opacities, typical of COVID-19 pneumonia.

Treatment commenced with Dexamethasone and Remdesivir alongside supplemental oxygen. Over the course of three weeks, her condition improved, and she was discharged with mild weakness but normal vital signs and no significant physical findings (SpO2 = 97%).

What sets this case apart is the subsequent development of CIDP, a chronic neurological condition. CIDP is a rare autoimmune disorder affecting the peripheral nervous system, causing progressive weakness and sensory disturbances. In this case, CIDP manifested in severe weakness in both upper and lower extremities, and it is noteworthy that this condition occurred either as a result of COVID-19 infection or vaccination or both.

Treatment for CIDP typically involves intravenous immunoglobulin (IVIG), and in both episodes, this therapy was initiated with a positive response from the patient. This case report marks one of the first reported instances of CIDP associated with COVID-19 infection and/or vaccination with a chronic course, highlighting the potential long-term effects of the virus and the need for vigilant monitoring.

In the broader context, this case underscores the importance of considering neurological complications such as Guillain-Barré syndrome (GBS) and CIDP in patients with COVID-19 or vaccinated against it, as they can lead to severe manifestations, including respiratory failure. Early diagnosis, differentiation between GBS and CIDP, and timely initiation of maintenance therapy are critical steps in preventing long-term disability.

This case report serves as a reminder that while COVID-19 primarily presents with respiratory symptoms, it can have diverse and far-reaching effects on the body, including the nervous system. Understanding these complexities is vital for providing comprehensive care and ensuring the best possible outcomes for patients.


REFERENCE

Abedi Samakoush M, Davoodi L, Khademian M, Kargar-Soleimanabad S, Abedini MA. New-onset chronic inflammatory demyelinating polyradiculoneuropathy after COVID-19 infection: a case report. Ann Med Surg (Lond). 2023 Jul 31;85(10):5031-5034. doi: 10.1097/MS9.0000000000000352. PMID: 37811109; PMCID: PMC10553086.

 2023 Oct; 85(10): 5031–5034.
Published online 2023 Jul 31. doi: 10.1097/MS9.0000000000000352




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