J Korean Med Sci.  2022 Feb;37(7):e58. 10.3346/jkms.2022.37.e58.

Guillain-Barre Syndrome After Two COVID-19 Vaccinations: Two Case Reports With Follow-up Electrodiagnostic Study

• Kim JW
• Kim YG
• Park YC
• Choi S
• Lee S
• Min HJ
• Kim MJ

• KMID: 2526521
• DOI: http://doi.org/10.3346/jkms.2022.37.e58

Abstract

Guillain-Barre syndrome (GBS) is an immune-mediated acute polyradiculoneuropathy and commonly occurs after a preceding infection or immunization sequalae. Following the severe acute respiratory syndrome-coronavirus-2 virus pandemic with co-introduction of massive vaccinations, several GBS cases associated with coronavirus disease 2019 (COVID-19) infection per se or after vaccination for COVID-19 were reported internationally. Herein, we report two cases of Korean GBS presenting with tetraplegia after two different COVID-19 vaccinations (42-year old man by AstraZeneca and 48-year woman by Pfizer vaccines) within four weeks after vaccination. The patients were diagnosed with clinical examination, serial electromyography, and compatible laboratory results and improved after comprehensive rehabilitative treatment and intravenous immunoglobulin therapy. Furthermore, we performed an electrodiagnostic follow-up study of each case to examine their unique characteristics.

Keyword

Guillain-Barre Syndrome (GBS); COVID-19 Vaccination; Electrodiagnosis; Comprehensive Rehabilitation Therapy; Case Report

Reference

1. World Health Organization. COVID-19 vaccines. Updated 2021. Accessed July 22, 2021. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines .

2. Flachenecker P. Epidemiology of neuroimmunological diseases. J Neurol. 2006; 253(Suppl 5):V2–V8. PMID: 16998750.

3. Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016; 388(10045):717–727. PMID: 26948435.

4. Public Health England. Information for healthcare professionals on Guillain-Barré Syndrome (GBS) following COVID-19 vaccination. Updated 2021. Accessed August 19, 2021. https://www.gov.uk/government/publications/covid-19-vaccination-guillain-barre-syndrome-information-for-healthcare-professionals .

5. Alexandrescu R, Siegert RJ, Turner-Stokes L. Functional outcomes and efficiency of rehabilitation in a national cohort of patients with Guillain-Barré syndrome and other inflammatory polyneuropathies. PLoS One. 2014; 9(11):e110532. PMID: 25402491.

6. Orlikowski D, Prigent H, Sharshar T, Lofaso F, Raphael JC. Respiratory dysfunction in guillain-barré syndrome. Neurocrit Care. 2004; 1(4):415–422. PMID: 16174943.

7. van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. 2014; 10(8):469–482. PMID: 25023340.

8. Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, Toyka KV, et al. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Ann Neurol. 1998; 44(5):780–788. PMID: 9818934.

9. Gordon PH, Wilbourn AJ. Early electrodiagnostic findings in Guillain-Barré syndrome. Arch Neurol. 2001; 58(6):913–917. PMID: 11405806.

10. Miller RG, Peterson GW, Daube JR, Albers JW. Prognostic value of electrodiagnosis in Guillain-Barré syndrome. Muscle Nerve. 1988; 11(7):769–774. PMID: 3405243.

11. Uncini A, Ippoliti L, Shahrizaila N, Sekiguchi Y, Kuwabara S. Optimizing the electrodiagnostic accuracy in Guillain-Barré syndrome subtypes: Criteria sets and sparse linear discriminant analysis. Clin Neurophysiol. 2017; 128(7):1176–1183. PMID: 28521265.

12. Allen CM, Ramsamy S, Tarr AW, Tighe PJ, Irving WL, Tanasescu R, et al. Guillain-Barré syndrome variant occurring after SARS-CoV-2 vaccination. Ann Neurol. 2021; 90(2):315–318. PMID: 34114269.

13. Maramattom BV, Krishnan P, Paul R, Padmanabhan S, Cherukudal Vishnu Nampoothiri S, Syed AA, et al. Guillain-Barré syndrome following ChAdOx1-S/nCoV-19 Vaccine. Ann Neurol. 2021; 90(2):312–314. PMID: 34114256.

14. Patel SU, Khurram R, Lakhani A, Quirk B. Guillain-Barre syndrome following the first dose of the chimpanzee adenovirus-vectored COVID-19 vaccine, ChAdOx1. BMJ Case Rep. 2021; 14(4):e242956.

15. Min YG, Ju W, Ha YE, Ban JJ, Lee SA, Sung JJ, et al. Sensory Guillain-Barre syndrome following the ChAdOx1 nCov-19 vaccine: report of two cases and review of literature. J Neuroimmunol. 2021; 359:577691. PMID: 34416410.

16. Waheed S, Bayas A, Hindi F, Rizvi Z, Espinosa PS. Neurological complications of COVID-19: Guillain-Barre syndrome following Pfizer COVID-19 vaccine. Cureus. 2021; 13(2):e13426. PMID: 33758714.

17. Scendoni R, Petrelli C, Scaloni G, Logullo FO. Electromyoneurography and laboratory findings in a case of Guillain-Barré syndrome after second dose of Pfizer COVID-19 vaccine. Hum Vaccin Immunother. 2021; 17(11):4093–4096. PMID: 34347563.

18. Wi YM, Kim SH, Peck KR. Early adverse events between mRNA and adenovirus-vectored COVID-19 vaccines in healthcare workers. Vaccines (Basel). 2021; 9(8):931. PMID: 34452055.

19. US Food & Drug Administration. Coronavirus disease 2019 (COVID-19). Updated 2022. Accessed December 18, 2021. https://www.fda.gov/emergency-preparedness-and-response/counterterrorism-and-emerging-threats/coronavirus-disease-2019-covid-19 .

20. European Medicines Agency. COVID-19 vaccine safety update: VAXZEVRIA AstraZeneca AB. Updated 2021. Accessed December 18, 2021. https://www.ema.europa.eu/en/documents/covid-19-vaccine-safety-update/covid-19-vaccine-safety-update-vaxzevria-previously-covid-19-vaccine-astrazeneca-9-december-2021_en.pdf .