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.

Keywords: COVID‐19 vaccines; ChAdOx1 COVID‐19 vaccine; Guillain–Barré syndrome; peripheral nervous system diseases.