Inflammatory demyelinating polyneuropathy after the ChAdOx1 nCoV-19 vaccine may follow a chronic course

Souza, Aaron de; Oo, Wai M.; Giri, Pradeep

doi:10.1016/j.jns.2022.120231

Cited by 22 publications

(16 citation statements)

References 39 publications

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“…CIDP is also reported as a possible consequence of vaccination, again with the majority of cases associated with adenovirus-based products (153)(154)(155). Brachial neuritis is also described as a post-vaccination complication in several reports (156)(157)(158), including patients receiving mRNA vaccines and usually ipsilateral to the side of vaccination (159).…”

Section: Vaccination Against Sars-cov-2 and Neuromuscular Complicationsmentioning

confidence: 99%

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

et al. 2022

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In this article we review complications to the peripheral nervous system that occur as a consequence of viral infections, with a special focus on complications of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). We discuss neuromuscular complications in three broad categories; the direct consequences of viral infection, autoimmune neuromuscular disorders provoked by viral infections, and chronic neurodegenerative conditions which have been associated with viral infections. We also include discussion of neuromuscular disorders that are treated by immunomodulatory therapies, and how this affects patient susceptibility in the current context of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is associated with direct consequences to the peripheral nervous system via presumed direct viral injury (dysgeusia/anosmia, myalgias/rhabdomyolysis, and potentially mononeuritis multiplex) and autoimmunity (Guillain Barré syndrome and variants). It has important implications for people receiving immunomodulatory therapies who may be at greater risk of severe outcomes from COVID-19. Thus far, chronic post-COVID syndromes (a.k.a: long COVID) also include possible involvement of the neuromuscular system. Whether we may observe neuromuscular degenerative conditions in the longer term will be an important question to monitor in future studies.

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Section: Vaccination Against Sars-cov-2 and Neuromuscular Complicationsmentioning

confidence: 99%

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

et al. 2022

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“…Immune neuropathies like GBS [ 3 , 4 ] and exacerbations of preexisting CIDP have been linked to SARS-CoV-2 infection and vaccination [ 5 ]. However, respective cases of A-CIDP are rare [ 2 , 6 , 7 ]. We hereby report two cases of A-CIDP after COVID-19 infection and Ad26.COV2.S vaccination.…”

Section: Introductionmentioning

confidence: 99%

Acute-onset chronic inflammatory demyelinating polyneuropathy complicating SARS-CoV-2 infection and Ad26.COV2.S vaccination: report of two cases

Fotiadou

Tsiptsios

Karatzetzou

et al. 2022

Egypt J Neurol Psychiatry Neurosurg

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Background The spectrum of reported neurological sequelae associated with SARS-CoV-2 is continuously expanding, immune mediated neuropathies like Guillain–Barre syndrome (GBS) and exacerbations of preexisting chronic inflammatory demyelinating polyneuropathy (CIDP) being among them. However, respective cases of acute onset CIDP (A-CIDP) are rare. Case presentation We hereby report two cases of A-CIDP after COVID-19 infection and Ad26.COV2.S vaccination that presented with flaccid paraparesis and acroparesthesias (Case presentation 1; female, 52) and facial diplegia accompanied by acroparesthesias (Case presentation 2; male, 62), respectively. In both instances clinical, neurophysiological and CSF findings were indicative of acute inflammatory demyelinating polyneuropathy, thus both patients were initially treated with intravenous immunoglobulins resulting in clinical improvement. Nevertheless, the first patient relapsed 5 weeks after the initial episode, thus was diagnosed with GBS with treatment related fluctuations (GBS-TRF) and treated successfully with seven plasma exchange (PLEX) sessions. However, 11 weeks from symptom onset she relapsed again. Taking into account that the second relapse occurred more than 8 weeks after the first episode, the potential diagnosis of A-CIDP was reached and oral dexamethasone 40 mg/d for 4 consecutive days every 4 weeks was administered. With regards to the second patient, he relapsed > 8 weeks after the initial episode, thus was also diagnosed with A-CIDP and treated with 7 PLEX sessions followed by similar to the aforementioned corticosteroid therapy. On 2 month follow-up both patients exhibited remarkable clinical improvement. Conclusions Close surveillance of patients presenting with immune neuropathies in the context of SARS-CoV-2 infection or immunization is crucial for timely implementation of appropriate treatment. Prompt A-CIDP distinction from GBS-TRF is of paramount importance as treatment approach and prognosis between these two entities differ.

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“…Whereas our case did not have any history of AIDP/GBS or CIDP. Souza et al reported a case series of four patients with CIDP after the ChAdOx1 nCoV-19 (AstraZeneca) vaccine [ 26 ]. While there have been a few studies examining the relationship between immunizations and chronic inflammatory neuropathies, most of them had limitations such as recall bias, retrospective design, and difficulty in precisely establishing the onset of disorders.…”

Section: Discussionmentioning

confidence: 99%