A case of sensory ataxic Guillain-Barré Syndrome with immunoglobulin G anti-GM1 antibodies following the first dose of mRNA COVID-19 vaccine BNT162b2 (Pfizer)

Japan, 22 November 2021, Fukushima et al, An International Journal of Medicine (accepted manuscript)

A 55-year-old woman with no medical history visited the hospital because of difficulty in walking for about 4 days. She had received the first dose of mRNA COVID-19 vaccine BNT162b2 13 days before her onset. No infectious symptoms, including diarrhea or coughing, preceded the difficulty walking. Deep tendon reflexes were absent generally. She had pseudoathetosis (Figure 1). A decrease in vibration sensation and warm pain sensation was reported in the limbs and trunk. Muscle weakness and autonomic or cranial nerve symptoms were absent.

Blood samples tested positive for IgG anti-GM1 and anti-SS-A antibodies but negative for other autoantibodies and infectious diseases. Cerebrospinal fluid findings showed protein 44.5 mg/dl, cell number 1/μl and sugar 70 mg/dl. Head magnetic resonance imaging (MRI), spinal cord MRI and neck-to-pelvis contrast-enhanced computed tomography findings showed no obvious abnormalities.

A nerve conduction study (NCS) performed on Day 1 of admission was normal. However, NCS on Day 6 demonstrated reduced amplitude of sensory nerve action potentials (SNAPs) in the median (Figure 2A and B), ulnar and peroneal nerves. Motor conduction study and F-wave persistence results were otherwise normal. Schirmer’s test and salivary gland biopsy results were negative.

Although the patient had no weakness, sensory GBS was diagnosed based on clinical presentation, supportive investigations and the exclusion of alternative diagnoses.

Intravenous Ig 0.4 gm/kg/day was administered for 5 days. Her symptoms improved rapidly after treatment initiation, and she was able to walk using a walker 3 days later and walk independently 10 days later. The extent of decreased temperature and pain sensation was localized to the forearm and parts of the trunk and thigh. She was transferred to a rehabilitation hospital 20 days after admission

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