Dados do Trabalho

Título

CSF PATTERN, SEVERE PROTEINORRACHI, IN GUILLAIN BARRÉ SYNDROME AFTER SARS-COV-2 VACCINE, ASTRAZENECA – REPORT IN 3 CASES.

RESUMO

ASE PRESENTATION:

1. RF, 22 years old, ten days after the 3rd dose of astrazeneca vaccine, develops bilateral paresthesia in hands and feet, the following day the deficit increases to limbs. After 4 days, there was loss of strength in proximal limbs, hypoesthesia in the tongue and mouth and dysphagia. In cerebrospinal fluid (CSF): protein 476 and 1 leukocyte. After 2 days, the deficit worsened with new 938 protein orrachia.
2. R, 52 years old, 1 week after the first dose of astrazeneca, developed paresis in the right lower limb, on the 8th day he presented the same complaint in the left lower limbs, both ascending, in addition to bilateral upper limbs. On the 10th day, a vesical and nasoenteral tube was needed. In lcr: 453.9 proteins and 1 leukocyte.
3. FD, 56 years old, ten days after the 3rd dose of astrazeneca vaccine, he develops paresthesia in the hands and feet and 1 day after the deficit ascends to the legs bilaterally. It evolves with loss of strength in feet and legs, in addition to urinary retention. In lcr: 1 leukocyte, 306.6 proteins.
All patients had MRIs of the skull and cervical spine, without changes and also without complaints of recent viral infection. In addition to an electroneuromyography study demonstrating demyelinating impairment. They also have a severe course with the need to repeat human immunoglobulin monthly

DISCUSSION:

The vaccine in question is composed of deficient replication of the adenovirus in chimpanzees, which stimulates the S glycoprotein of COVID 19, producing T cells and antibodies, which generates a molecular mimicry generating the attack on the myelin sheath, which culminates in guillain-barré syndrome ( GBS). In all the cases presented, a closed diagnosis and clinical, cerebrospinal fluid and Enmg criteria. A common fact that draws attention is the high increase in protein, creating a CSF pattern for GBS post-ChAdOx 1 vaccine, not yet evidenced in the literature.

FINAL COMMENTS:
Even though it is a rare occurrence, post-AstraZeneca vaccine GBS, totaling 27 cases in Brazil until 07/2021, being included as an adverse event in the immunization package insert. Given this fact, added to the importance of vaccination, since it reduces about 80% hospitalizations in the elderly. It is extremely important to create a pattern for this new etiology of GBS, studying not only a new cerebrospinal fluid pattern, seen in an important proteinorachie report, but also clinical and electroneuromyography.

Palavras Chave

Csf, severe proteinorrachi, guillian barre, sars-cov-2 vaccine, astrazeneca