Abstract
We present a case of an 86-year-old woman who presented with a progressive quadriparesis two days after her second dose of Moderna SARS-CoV-2 vaccine, with cerebrospinal fluid (CSF) evidence of cytoalbuminocytological dissociation and electromyogram/nerve conduction studies (EMG/NCS) findings suggestive of acute axonal motor neuropathy. Her clinical symptoms did not improve with plasmapheresis.There appears to be a potential temporal association between the inoculation of mRNA-based SARS-CoV-2 vaccines and the development of Guillain-Barre Syndrome (GBS). Despite this possible association, infection prevention using highly effective mRNA-based vaccines remains highly recommended. Large epidemiological studies of SARS-CoV-2 vaccine-related adverse events are needed. Physicians should be aware of this possible temporal association since the prompt diagnosis and treatment of GBS can drastically improve outcomes.The aim is to report a case of axonal-variant GBS that was temporally associated with an mRNA-based SARS-CoV-2 vaccine.
Highlights
Guillain-Barre syndrome (GBS) is an immune-mediated polyradiculoneuropathy that often presents as an acute paralyzing illness preceded by an infection, or less commonly, immunizations [1]
Various case reports of GBS after SARS-CoV-2 infections raised the concern of a possible post-infectious association; a recently published large epidemiological study failed to demonstrate a statistically significant correlation [2]
There were very few cases of GBS observed in the safety trials for all SARS-CoV-2 vaccines and only two reported cases in clinical practice
Summary
Guillain-Barre syndrome (GBS) is an immune-mediated polyradiculoneuropathy that often presents as an acute paralyzing illness preceded by an infection, or less commonly, immunizations [1]. An 86-year-old woman with atrial fibrillation, diabetes mellitus type 2, aortic stenosis, and ischemic stroke with no residual deficits presented with lower extremity weakness and pain Her neurological examination progressed from a subtle paraparesis to a dense lower-extremity predominant quadriparesis within one week. Confirmatory electromyography and nerve conduction studies (NCS) were performed which demonstrated low amplitude right peroneal, tibial, and ulnar motor evoked responses with normal distal latencies, segmental conduction velocities, and sensory responses, consistent with acute axonal motor neuropathy. She was treated with plasmapheresis for five sessions without notable improvement in her strength
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