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Título

SEVERE CHRONIC RECURRENT DEMYELINATING POLYNEUROPATHY AFTER A SINGLE DOSE OF CHADOX1-S NCOV-19: A CASE REPORT

Resumo

Case presentation: Female, 33 years old, was vaccinated with a single dose of ChAdOx1-S nCOV-19 (Fiocruz-AstraZeneca) at 02/02/2022. She was admitted to an emergency unit on 02/26/2021 with complaints of paresthesia in palate and limbs. CSF analysis showed: glucose of 52 mg/dL; proteins 72 mg/dL; 1 cell/mm3; and C. jejuni IgG ELISA indeterminate levels (0.93). Electroneuromyography (ENMG) identified acute motor and sensory demyelinating polyneuropathy on all four limbs. She evolved within 2 days with distal flaccid tetraparesis, dysphonia, dysphagia and dyspnea. At this point, a diagnosis of Guillain-Barré Syndrome (GBS) was made. Intravenous human immunoglobulin (IVIG) was started 3 days after symptom onset. Five days after IVIG, she developed facial diplegia, worsening of tetraparesis, and dysautonomia. A new IVIG infusion was performed 6 days after the first one, with improvement of limb paresis. In march 2021 she was readmitted with worsening of the facial diplegia, and plasmapheresis was instituted with good results. In april 2021 she returned with worsening dysphonia and paresis, with weak positivity to c-ANCA. Thus, suspicion was changed to ANCA-related vasculitis associated with polyneuropathy. She was then treated with methylprednisolone and cyclophosphamid, evolving with worsening of clinical state with need of mechanical ventilation. A new plasmapheresis and rituximab were performed, with a good clinical response. She was readmitted in May 2021 with worsening weakness and treated with plasmapheresis and IVIG. Specific antibodies were negative for systemic vasculitis, and a diagnosis of recurrent chronic demyelinating polyneuropathy (CIDP) was made. It was opted for a monthly maintenance of IVIG from 08/2021 until the present time. Currently, the patient is stable with preserved muscle strength. Discussion and conclusion: CIDP is characterized by autoimmune, inflammatory, demyelinating lesions affecting peripheral nerves and nerve roots, with a chronic or remitting/recurrent course of neurological disability and is treatable with immunomodulatory therapies. Neurological complications have been reported after COVID-19 vaccination and C. jejuni infection. Longitudinal follow-up confirms the diagnosis of CIDP; the causal relationship with COVID-19 vaccination is possible considering other similar case reports on literature. The absence of diarrhea and the weak antibody reactivity against C. jejuni decrease the chance of this agent as etiology.

Palavras Chave

Polyneuropathy; COVID-19; vaccine; ChAdOx1 nCoV-19