Facial Diplegia as the Sole Manifestation of Post-Vaccination Guillain-Barre Syndrome: A Case Report and Literature Review

Abstract

Introduction: Recently, a large study concluded that certain brands of vaccines may increase the risk of Bell's palsy and Guillain Barre Syndrome (GBS). As to whether vaccination after COVID-19 modify the risk of Bell's palsy or GBS has not yet been studied.

Case: Here we report a 35 years old COVID-19 survivor whom in less than 2 weeks after his second dose of inactivated SARS-CoV2 vaccine, developed bilateral facial nerve paralysis. In addition, he had hyperacusis, dysgeusia and decreased lacrimation without any signs of sensory and motor deficits in the limbs. His limb nerve conduction study (NCS) was unremarkable in contrast to bilaterally abnormal facial NCS and blink reflexes. Although he had negative anti-GM1 IgG and IgM antibodies, he has marked albuminocytologic dissociation, classic of acute inflammatory demyelinating polyneuropathy.

Conclusion: To date, there were no similar case reports which published the occurrence of facial diplegia as sole manifestation of GBS in a post COVID-19 patient who recently completed vaccination. We believe that molecular mimicry, induced by magnified immune response from both COVID-19 and vaccination may have caused the symptom.

Keywords: Bilateral Bell’s palsy; COVID 19; Guillain Barre Syndrome; inactivated SARS-CoV2 vaccine; molecular mimicry.

Figure 1.

(A-D) These were the patient’s facial muscles during (A) rest, (B) when instructed to look up, (C) when instructed to close eyes, (D), when instructed to pull the corners of his mouth. (Consent was provided by the patient not to censor his eyes in order to illustrate the full facial diplegia).