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Título

GUILLAIN BARRÉ SEVERE SYNDROME (GBS) PROBABLY ASSOCIATED WITH VACCINATION FOR COVID-19

RESUMO

Case report: Female patient, 60 years old, hypertensive, presented insidious lower limb (LL) weakness associated with tactile-painful hypoesthesia. In five days, there was a progression of weakness with impairment of walking, which motivated the visit to the hospital. She denied fever, diarrhea, or respiratory infection symptoms preceding her current condition, but a vaccine reference for COVID-19 (Astrazeneca) fifteen days earlier. On examination: hypotonia in the LL, reflex absence globally, grade IV strength in the upper limbs (UL), grade III proximal, grade II distal in the LL, and peripheral facial diparesis.
Performed cranial CT with no alterations and cerebrospinal fluid (CSF) with protein of 141mg / dL, glucose: 80mg / dL; WBC: 0. Screening for nasopharyngeal SARS-CoV-2 using rapid SWAB test, negative.
Based on the above, the suspicion of SGB was raised. Intravenous immunoglobulin infusion (IVIG) was started, followed by clinical worsening of the degree of strength (LL and UL grade 0) and presence of dysautonomia (sustained tachycardia and arterial hypertension). After the end of IVIG, the patient established dysphagia, dysphonia, and dyspnea. Due to the clinical deterioration, we opted for a new IVIG cycle, with an additional 1g / Kg being a total dose, divided into three days. There was an improvement in swallowing, dyspnea, upper limb strength (proximal grade II, distal grade III), and reversal of dysautonomia.

Discussion: GBS is an acute inflammatory disease of the peripheral nerves that commonly presents with progressive symmetrical weakness and areflexia, resulting in respiratory failure. Annual report of 1 to 2 cases / 100,000 inhabitants and peak between 20-40 years, being somewhat more common in men. It can result from an immune response that occurs 3-6 weeks after a previous acute illness, infection, or trigger in 50% of cases. Still, it can also be associated with immunization, surgery, and trauma, for example. A relationship between COVID-19 infection and many neuropathies, including GBS, has been reported. However, we still do not have full knowledge of GBS related to immunization against COVID-19.

Conclusion: It is essential to remember the need to pay attention in clinical practice to GBS causes in a scenario of such a recent and devastating infection as COVID-19 and its newly discovered vaccines. Extensive studies are needed.

Palavras Chave

GUILLAIN BARRÉ; VACCINATION; ASTRAZENECA