Reactions 1871, p84 - 4 Sep 2021
AZD-1222 S
Guillain-Barre syndrome: case report
A 48-year-old man developed Guillain-Barre syndrome (GBS) following administration of AZD-1222 [route not stated].
The man from Malta, who had a medical history of dyslipidaemia, received first dose of AZD-1222 [Vaxzevria]. Ten days later, he presented due to left-sided lower motor neuron facial weakness, initially House Brackmann grade III. He was diagnosed with Bell’s palsy. He started receiving prednisolone, unspecified eye drops and eye care in addition to physiotherapy. He also demonstrated mid-thoracic back pain. Despite treatment with unspecified analgesics mid thoracic pain persisted. In the following 24h, his facial weakness progressed with involvement of the right side of face. Thirteen days later (post vaccination), he presented to the neurology department due to House Brackmann grade V paralysis bilaterally. He demonstrated severe back pain. His neurological investigations were unremarkable. Cranial nerve examination was unremarkable except for facial weakness along with full extraocular movements, normal tone, full power grade 5 on 5 on the modified Medical Research Council (MRC) Scale. All peripheral reflexes 2+ bilaterally and down going plantar responses bilaterally, in addition to normal sensory examination and normal gait. He was then hospitalised for further investigations. Bran CT and MRI were unremarkable. Haematological workup was also unremarkable. Lumbar puncture revealed elevated protein and lymphocytes level. Anti-ganglioside antibodies and oligoclonal bands were negative. The patient was diagnosed with GBS. For the following 3 days he remained stable with facial weakness showing a significant improvement.
The man’s therapy with prednisolone was continued and discharged home. In the following 24h, he presented to the emergency department due to ascending paraesthesia and bilateral progressive lower limb weakness. Investigations revealed lower limb weakness with foot drop and inability to weight bear moderately severe hand weakness and loss of his lower limb reflexes. His sensations for pain was also impaired in a glove and stocking distribution. He tested negative for SARS-CoV-2 infection. He was then treated with IV immune globulin, in addition to prednisolone. he showed a complete resolution of the facial weakness. by this time he was areflexic in the lower limbs with bilateral foot drop and bilateral lower limb weakness. He was able to walk with the help of a rollator frame. Investigations on nerve conduction revealed a severe, multifocal sensorimotor demyelinating polyneuropathy along with reduced compound motor action potentials throughout, reflecting likely hypoexcitability. He showed a rapid and a significant improvement. His respiratory condition was stable during hospitalisation. Later, he underwent intensive physiotherapy and started mobilising without support of rollator frame and discharged home. At 2 month follow-up, he had only mild residual weakness of modified MRC Scale 4 on 5 of the hand intrinsic muscles bilaterally. hyporeflexia 1+ bilaterally in all upper limb reflexes, full power in the lower extremities, apart from grade 4 on 5 in the extensor hallucis longus bilaterally. Ankle reflexes remain absent and sensation to all modalities is intact.
McKean N, et al. Guillain-Barre syndrome after COVID-19 vaccination. BMJ Case Reports 14: No. 7, 30 Jul 2021. Available from: URL: http://doi.org/10.1136/
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