Guillain–Barré syndrome after coronavirus disease 2019 vaccine: A temporal association

Abstract

Background Guillain–Barré syndrome (GBS) is an acute monophasic immune‐mediated polyradiculoneuropathy, preceded by gastrointestinal or respiratory infections in up to two‐thirds of patients. On rare occasions, people develop GBS after vaccination, but no causal association has been proven. In the current coronavirus disease 2019 (COVID‐19) pandemic, some cases have been reported associating COVID‐19 vaccine with GBS. Case presentation We report a case of a 62‐year‐old woman with GBS after the first dose of the Oxford/AstraZeneca vaccine against SARS‐CoV‐2. The symptoms started 3 weeks after the vaccine, and were characterized by ascending and progressive paresthesia in the upper and lower limbs, followed by loss of strength of the upper limbs and dysphagia for solids. The hypothesis of GBS was confirmed by clinical presentation compatible with albuminocytologic dissociation in cerebrospinal fluid and based on the Brighton criteria level 2. The treatment was a 5‐day course of intravenous immunoglobulin with an improvement of symptoms. Conclusions In the absence of other causes, the diagnosis of GBS was made, with evidence of a clear temporal association with COVID‐19 vaccine. However, a cautious position is important when assigning a particular side‐effect directly to a vaccine. It is important to emphasize that it is a temporal association only and the benefits of COVID‐19 vaccination continue to outweigh the possible consequences.

Response to “Nerve conduction studies support the classification of SARSCoV‐2 associated Guillain‐Barre subtypes”

“…Dear Editor, We read with interest the comments made by Finsterer et al 1 on our previously published case report "Guillain-Barré syndrome after coronavirus disease 2019 vaccine: A temporal association". 2 We understand that the comments made are interesting points of discussion.…”

Nerve conduction studies support the classification of SARS‐CoV‐2 associated Guillain‐Barre subtypes

“…Letter to the Editor We read with interest the article by da Silva et al about a 62-year-old female who developed paresthesias of the distal limbs 18 days after the first dose of AstraZeneca's vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 1 The patient developed weakness of the lower and upper limbs 2 and 3 weeks later, respectively, 1 and was admitted to hospital 2 months after the onset of these symptoms because of facial diplegia and quadriparesis, dysphagia, and absent tendon reflexes. 1 The patient was diagnosed with Guillain-Barre syndrome (GBS), with a score of 2 according to the Brighton criteria based on the clinical presentation and the dissociation cyto-albuminique in the cerebrospinal fluid (CSF).…”

“…3 We disagree that only a few cases of SARS-CoV-2-vaccinationassociated GBS (SC2VaG) have been reported. 1 In a recent review of the neurological side effects of SARS-CoV-2 vaccines, 300 cases of SC2VaG were described. 4 We should be told why it took 2 months from the onset of GBS for the patient to be diagnosed with SC2VaG.…”

“… 1 The patient developed weakness of the lower and upper limbs 2 and 3 weeks later, respectively, 1 and was admitted to hospital 2 months after the onset of these symptoms because of facial diplegia and quadriparesis, dysphagia, and absent tendon reflexes. 1 The patient was diagnosed with Guillain–Barre syndrome (GBS), with a score of 2 according to the Brighton criteria based on the clinical presentation and the dissociation cyto‐albuminique in the cerebrospinal fluid (CSF). 1 The patient only partially recovered with administration of immunoglobulins.…”

“… 1 The patient was diagnosed with Guillain–Barre syndrome (GBS), with a score of 2 according to the Brighton criteria based on the clinical presentation and the dissociation cyto‐albuminique in the cerebrospinal fluid (CSF). 1 The patient only partially recovered with administration of immunoglobulins. 1 The study is appealing but raises concerns that need to be discussed.…”