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Título

Guillain-Barré syndrome after COVID-19 vaccination: case series

Resumo

INTRODUCTION: Guillain-Barré syndrome (GBS) is an acute or subacute immune-mediated polyradiculoneuropathy generally preceded by an infectious trigger. The first link between GBS and vaccines was an 8-fold increase in incidence of GBS in receivers of a Swine influenza vaccine in 1976. Recently, MMR, HPV, MCV4 and Influenza vaccines were pointed as possible triggers, but this association is questionable. During the coronavirus (COVID-19) pandemic, cases of GBS preceded by COVID-19 vaccination have been reported, especially associated with viral vector-based vaccines. OBJECTIVE: To describe cases of GBS diagnosed within 6 weeks after COVID-19 vaccination during the mass vaccination period. METHODOLOGY: We performed a retrospective review of all patients diagnosed with GBS within 6 weeks after receiving COVID-19 vaccination admitted at our service from January 19th, 2021 to August 22nd, 2021. Exclusion criteria was the presence of other probable triggers during this period, including documented COVID-19 infection. Collected data include gender, age, vaccine received, time between vaccination and symptoms onset (latency), neurological manifestations, cerebrospinal fluid analyses, electrophysiological study, treatment and outcome at hospital discharge. RESULTS: During the studied period, 7 patients met the inclusion criteria (6 men and 1 woman) with an average age of 53,4 years old. 6 received ChAdOx1-S vaccine (AstraZeneca) and 1 received Ad26.COV2.S vaccine (Janssen). Except for one patient, who developed symptoms 1 day after immunization, all other patients had a latency time between 12 and 23 days. We identify that 5 of 6 patients who underwent lumbar puncture had an albuminocytological dissociation. Among the 5 patients who underwent electrophysiological study, 3 met the criteria for the variant of AIDP, 1 met borderline criteria for AIDP and 1 had a pattern compatible with AMSAN. Clinical presentation was heterogeneous, requiring individualized treatment. The patients received intravenous immunoglobulin, plasma exchange or both. The 3 non-severe patients were discharged with mild to moderate paresis and among the 4 patients that required intensive care, one was discharged to rehabilitation with tetraparesis and 3 were transferred to other services. CONCLUSION: This study reported cases in which there was temporal association between COVID-19 vaccines and development of GBS. Further studies are required to establish if there is a causal relation.

Palavras Chave

Guillain-Barré syndrome. Vaccination. COVID-19.