A Clinical Case of COVID-19 Vaccine-Associated Guillain-Barré Syndrome

BACKGROUND Guillain-Barre syndrome (GBS) is an autoimmune condition that presents as weakness, numbness, paresthesia, and areflexia. GBS may occur following infection or vaccination. The pathogenesis of GBS is characterized by inflammatory infiltrates and segmental demyelination. The mechanism of GBS following COVID-19 vaccination is hypothesized to arise from an autoimmune-mediated mechanism leading to an increase in inflammatory cytokines. While there were no reported cases of GBS during the mRNA COVID-19 vaccination clinical trials, there have been a few case reports of GBS following COVID-19 vaccination. CASE REPORT We report a case of symmetric weakness and paresthesia that began 3 days after the patient received his first dose of the Moderna COVID-19 vaccine. Cerebrospinal fluid (CSF) studies demonstrated albuminocytologic dissociation. The combination of the patient's CSF findings and clinical symptoms was concerning for Guillain-Barre syndrome. Given the clinical findings 3 days following COVID-19 vaccination, there was a high concern for COVID-19 vaccine-induced GBS. The patient was treated with IVIG followed by plasmapheresis but failed to show significant improvement from either treatment. CONCLUSIONS Our case report demonstrates occurrence of GBS soon after the patient received the COVID-19 Moderna vaccine. Although rare, there is some evidence to support an association between COVID-19 vaccination and GBS, but this is generally limited to case reports and case series. Clinicians, however, should remain vigilant to mitigate potential risks, such as autonomic dysfunction, respiratory failure, permanent disability, and death in patients who develop GBS after vaccination.