Two possible etiologies of Guillain-Barré syndrome: mRNA-1273 (Moderna) vaccination and scrub typhus: A case report

Abstract

Rationale: Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuropathy related to infection with bacteria or virus and vaccination. Cases of GBS after coronavirus infection-19 (COVID-19) vaccination have been reported. However, cases of GBS after inoculation with mRNA-based COVID-19 vaccines, especially mRNA-1273, have rarely been reported compared to after inoculation with adenovirus vector-based COVID-19 vaccines. On 1 hand, GBS occurring after scrub typhus is often reported, but the exact pathological mechanism has not been elucidated. We report the case of a patient with GBS after inoculation with mRNA-1273 COVID-19 vaccine and scrub typhus.Patient concerns: A 47-year-old man received COVID-19 vaccination 4 weeks before admission. He had a fever, rash and general weakness 1 day after vaccination. After 3 weeks, the muscle strength of the extremities deteriorated to the extent that walking was impossible. Diagnosis, interventions, and outcomes:The patient developed quadriplegia with areflexia, axonal-type sensorimotor polyneuropathy was confirmed by nerve conduction study. The patient was diagnosed as GBS. Scrub typhus was also diagnosed as eschar was observed in the chest area and the serologic test of anti-R-tsutsugamushi antibody showed a strongly positive result. The patient received treatment with intravenous immunoglobulin at 0.4 g/kg daily for 5 days. Mechanical ventilation was applied during the intensive care unit. He was treated for scrub typhus simultaneously. Six months after the onset of the disease, the patient showed improvement to the point where he could work and exercise alone.Lessons: When GBS is suspected, early evaluation and treatment can lead to favorable outcomes. Considering that cases of GBS after COVID-19 vaccination have been reported, it is important to conduct early evaluation and management of patients with muscle weakness after COVID-19 vaccination to ensure early detection of GBS. And even if fever and rash are side effects that can occur frequently after vaccination, it is necessary to consider other diseases in addition to the side effects of the vaccine. This is to prevent delay in diagnosis and treatment of other diseases.

Neuromuscular diseases associated with COVID-19 vaccines: a systematic review and pooled analysis of 258 patients

“…Also, a total of 42 definite incident cases of MG occurred following Influenza and Hepatitis B vaccines in American adults between 1990 and 2017 [ 150 ]; these cases had a higher mean (SD) time from vaccine to symptoms compared to MG cases associated with COVID-19 vaccines (10 (10.7) vs 7.1(6.6), respectively). Overall, MG is mainly diagnosed between 10 and 70 years old [ 23 , 24 ], and affected female patients are younger than their male counterparts (mean age: 28 vs. 42 years, respectively) [ 25 ]. Gender ratio differs by MG type; contrary to pure ocular or bulbar MG, cases with generalized MG are predominantly female (female/male ratio: 3:2 or higher) [ 26 ].…”

Neuromuscular diseases associated with COVID-19 vaccines: A systematic review and pooled analysis of 258 patients

“…Repetitive nerve stimulation (RNS) was positive in 13 out of 15 Also, a total of 42 de nite incident cases of MG occurred following In uenza and Hepatitis B vaccines in American adults between 1990 and 2017 150 ; this cases had a higher mean (SD) time from vaccine to symptoms compared to MG cases associated with COVID-19 vaccines (10 (10.7) vs 7.1(6.6), respectively). Overall, MG is mainly diagnosed between 10 to 70 years old (23,24), and affected female patients are younger than their male counterparts (mean age: 28 vs. 42 years, respectively) (25). Gender ratio differs by MG type; contrary to pure ocular MG, cases with generalized MG are predominantly female (female/male ratio: 3:2 or higher)(26).…”