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Título

Guillain-Barré Syndrome Post Vaccine: A Case Report

RESUMO

A 23 year old, male patient on March 6th started to feel paresthesia in both hands with later progression to his feet at night. After two days, he progressed with dysphagia and quadriparesis and worsening of paresthesia, later being admitted in an emergency room and being transferred within 01 day to an ICU of a tertiary hospital. He denied any infections prior to his symptoms and said that he was vaccinated with his third dose of SARS COV 2 vaccine (Astrazeneca) within 14 days before his symptoms
On physical examination, he presented flaccid quadriparesis with abolished reflexes in lower limbs and diminished in upper limbs with facial diplegia and bulbar palsy, with no sensitive impairments.
Electromyogram was performed on the fourth day of onset, with no significantly findings .CSF was analyzed and showed albuminocytologic dissociation. MR showed no abnormalities
He was treated with IVIG for 05 days and two days after the IVIG course he developed respiratory insufficiency and disautonomia and had cardiac respiratory arrest during rapid sequence intubation. He was resurrected after eleven cycles and after two days he developed diffuse brain swelling and elevated ICP, being monitored with an intraventricular ICP device, and after one week he developed refractoriness to clinical treatment, being submitted to an EVD. He died two days after.
The Guillain-Barré syndrome is an acute autoimmune disorder after infection or rarely to immunization in susceptible individuals. Autoimmune antibodies that recognize gangliosides are found in a large proportion of GBS patients and are thought to contribute to the ultimate pathology by inducing complement-mediated axonal injury and demyelination.1 The first case of GBS following COVID-19 vaccination was reported in February 2021 in the USA in an elderly female who presented 2 weeks after the first dose of the vaccine.2 Also, it has been reported GBS syndrome after SARS COV2 infection, with approximately ten days between viral infection and the development of GBS syndrome.3 One narrative review showed nine articles reporting 18 cases of SARS COV2 Vaccine associated GBS Syndrome4
We described a male patient of 23 year old who developed a flacid arreflex quadriparesis and bulbar palsy with albuminocytologic dissociation within 14 days of vaccination with Astrazeneca, who had refractoriness to IVIG and died after complications from cardiac arrest.
This report is importante due to the rarity of GBS induced by vaccination.

Palavras Chave

Guillain-Barré Syndrome; COVID-19; Vaccine