Guillain-Barré syndrome and fulminant encephalomyelitis following Ad26.COV2.S vaccination: double jeopardy

Abstract

This correspondence comments on a published article presenting a case of rhombencephalitis following SARS-CoV-2-vaccination with the mRNA vaccine BNT162b2 (Pfizer/BioNTech). We also present the case of a 47-year-old man who developed Guillain-Barré-syndrome and a fulminant encephalomyelitis 28 days after immunization with Ad26.COV2.S (Janssen/Johnson & Johnson). Based on the presented cases, we underscore the importance of clinical awareness for early recognition of overlapping neuroimmunological syndromes following vaccination against SARS-CoV-2. Additionally, we propose that that role of autoantibodies against angiotensin-converting enzyme 2 (ACE2) and the cell-surface receptor neuropilin-1, which mediate neurological manifestations of SARS-CoV-2, merit further investigation in patients presenting with neurological disorders following vaccination against SARS-CoV-2.

Keywords: Ad26.COV2.S; Encephalomyelitis; Guillain-Barré syndrome; SARS-CoV-2 vaccine; Transverse myelitis.

Fig. 1

A Coronal T2-weighted MRI displays hyperintense signal along the corticospinal tracts bilaterally (“wine glass” sign). B On axial fluid attenuated inversion recovery (FLAIR), a hyperintense lesion is shown in the left middle cerebellar peduncle (green arrow). On brain MRI, no contrast enhancing lesions or lesions with diffusion restriction were depicted, while the optic nerves had normal appearance (images not shown). C Sagittal T2-weighted spine MRI shows longitudinally extensive thoracolumbar spinal cord lesions, with combined gray/white-matter involvement, affecting more than two-thirds of the thoracic spinal cord’s cross-sectional area on axial T2-weighted MRI sequence (D), findings compatible with transverse myelitis. E Sagittal T1-weighted gadolinium-enhanced MRI reveals contrast-enhancing lesions in the cervical and thoracic spinal cord (purple and orange arrows, respectively)