Distal Chronic Inflammatory Demyelinating Polyneuropathy Following COVID-19 Vaccination in a Patient with Solitary Plasmacytoma: A Case Report and Literature Review

Abstract

We herein report a rare case of distal chronic inflammatory demyelinating polyneuropathy (CIDP) following coronavirus disease 2019 (COVID-19) vaccination. A 39-year-old woman with a solitary plasmacytoma developed general weakness 7 days after receiving the second dose of the Pfizer-BioNTech COVID-19 vaccine, which had progressed for 3 months. A neurological examination revealed limb weakness with areflexia. Serological tests identified the presence of IgG antibodies against anti-GM1 and anti-GM2 gangliosides. Comprehensive evaluations met the criteria of distal CIDP. Intravenous immunoglobulin, intravenous methylprednisolone, oral prednisolone, and plasma exchange were administered, and she gradually improved. Physicians should be aware of CIDP as a rare complication of COVID-19 vaccination.

Keywords: CIDP; COVID-19; anti-ganglioside antibody; myeloma; plasmacytoma; vaccination.

Figure 1.

(A-B) Brain magnetic resonance imaging (MRI) shows an increased signal of fluid-attenuated inversion recovery in the deep white matter and the left temporal bone. (C) Brain gadolinium-enhanced MRI shows an enhanced mass in the left temporal bone. (D) Lumbar gadolinium-enhanced MRI on admission day 9 revealed an enhanced and swollen cauda equina. (E) Lumbar gadolinium-enhanced MRI on admission day 44 revealed slight improvements in the enhanced and swollen cauda equina. (F-G) Short tau inversion recovery sequence MRI shows an increased signal and hypertrophy in the lumbar nerve root.

Figure 2.

A nerve conduction study of the compound muscle action potential (CMAP) revealed a 33.3% (≤50%) delay in the distal latency of the right median nerve. Abnormal temporal dispersion was observed in the right median nerve. A 32.3% (>30%) reduction in the motor conduction velocity was observed in the right median nerve.