Sensory Guillain-Barre syndrome following the ChAdOx1 nCov-19 vaccine: Report of two cases and review of literature

Abstract

Massive vaccination against COVID-19 has become a global priority. Simultaneously, concerns regarding the safety of vaccines are growing. We describe two patients who developed sensory Guillain-Barre syndrome (GBS) shortly after the first dose of the ChAdOx1 vaccine. We also summarize 12 published cases of GBS after ChAdOx1 vaccination, highlighting their unique clinical and paraclinical features. We propose a possible association between the risk of GBS and the ChAdOx1 vaccine and recommend surveillance for GBS following vaccination. Population-based studies are needed to determine causality and whether specific subpopulations are susceptible.

Keywords: COVID-19; ChAdOx1; Guillain-Barre syndrome; SARS-CoV-2; Vaccines.

Graphical abstract

Fig. 1

Skin biopsy and electrophysiological findings of patient 1 (A, D) and patient 2 (B, E). (A) Intraepidermal nerve fiber density (IENFD), immunostained by protein gene product 9.5, was decreased in patient 1's distal leg (2.7/mm, age- and sex-matched cut-off 9.1) (Provitera et al., 2016). (B) Distal leg IENFD was also decreased in patient 2 (6.2/mm, age- and sex-matched cut-off 11.3). (C) Representative example of normal IENFD in healthy control. (D) Peroneal motor nerve conduction study (NCS) of patient 1 showed temporal dispersion, indicative of demyelination. (E) The quantitative sudomotor axon reflex test (QSART) in patient 2 was impaired in the forearm (abnormal) and distal leg (low normal) (reference value shown in the figure). Scale bars = 50 μm.