Post-vaccination Guillain-Barre syndrome: a case report

Case presentation: Girl, 9 years old, started weakness in lower limbs, frequent falls with progressive worsening of ascending weakness and later distal involvement of upper limbs, in addition to burning pain in the calves. About eight days before the condition, she received vaccination with the 2nd dose of coronavac. At the initial evaluation, the patient had normal cognitive examination, incomplete tetraparesis with symmetrical crural predominance, on the MRC scale in lower limbs grade II and in upper limbs grade IV, absent osteotendinous reflexes, preserved superficial and deep sensitivity, cranial nerves without alterations. Normal sphincter function. Analysis of cerebrospinal fluid on the 3rd day of symptoms without alterations, however, in an electroneuromyographic study, non-length dependent multifocal motor axonal polyneuropathy was evidenced compatible with Guillain-Barré syndrome (AMAN variant). The patient was treated with intravenous human immunoglobulin for five days, in view of the evidence of clinical worsening over the five days due to the appearance of new superficial hypoesthesia and electroneuromyographic worsening that showed multifocal and non-length-dependent sensory and motor axonal polyneuropathy (AMSAN)., performed five sessions of plasmapheresis, with partial improvement.

Discussion: Guillain-Barré syndrome is characterized by post-trigger autoimmune peripheral nerve involvement, in most cases infectious, either of the myelin sheath or of the axon itself, which classically courses with acute/subacute ascending a reflex weakness, with symptoms peaking at around 2 to 3 weeks. Typically, a cytological protein dissociation is observed in the CSF, but many patients may not experience dissociation in the first three weeks. Another useful test, especially for classifying the pattern of involvement, is electroneuromyography. Acute treatment involves intravenous human immunoglobulin and/or plasmapheresis, in addition to symptomatic treatment and clinical support. Chronic treatment involves a multidisciplinary team to ensure rehabilitation.

Final comments: We considered the case of interest for exposure, in view of the temporal report of vaccination with the coronavac vaccine, without other possible triggers associated with the outbreak of the condition. It is important to know the syndrome for the correct diagnosis and follow-up of these patients.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023