Guillain-Barré Syndrome Following the First Dose of Inactivated SARS-CoV-2 Vaccine, BBIBP-CorV - Cureus

A 41-year-old male with benignant 2 diabetes presented with numb legs and symptom successful his precocious backmost and was admitted to a teaching hospital. He was connected metformin 500mg regular for the past year. Pain and numbness started 18 days aft receiving the archetypal dose of BBIBP-CorV. Numbness worsened implicit the adjacent week to impact each 4 limbs, and by the ninth day, helium developed bilateral facial weakness. He did not study caller respiratory oregon diarrheal disease.

He had a mitt and stocking-type sensory nonaccomplishment to touch, up to the elbow and genu level, with intact pain, temperature, and associated presumption sensation. All four-limb musculus powerfulness was normal, with a 5/5 Medical Research Council standard with diminished heavy tendon reflexes. Cerebellar, autonomic, and respiratory functions were preserved, and but for isolated bilateral little centrifugal neuron-type facial palsy different cranial nerves, including bulbar functions, were intact. The diligent had a disablement standard of 2 connected the GBS disablement scale [6].

Cerebral-spinal fluid (CSF) investigation connected time 13 of the unwellness revealed a compartment macromolecule dissociation, with elevated CSF macromolecule (62.2 g/dL) and a mean compartment number of 5 lymphocytes per mm³ corroborating the GBS diagnosis. On the aforesaid day, a nervus conduction survey (NCS) was performed (Tables 1, 2) and revealed reduced motor nervus conduction velocities successful bilateral peroneal nerves and prolonged distal centrifugal latencies successful the bilateral peroneal and close tibial nerve. The sensory effect successful the close ulnar nervus was not detected, but the bilateral sural sensory effect was preserved. We could not put a follow-up study.

Serum sodium was debased astatine 123 mmol/l, and serum osmolarity was mean astatine 275 mOsm/kg. The urine osmolarity was abnormally precocious astatine 400 mOsm/kg. The urine sodium level was 45 mmol/l, confirming the syndrome of inappropriate antidiuretic hormone accumulation (SIADH), a recognized effect of GBS. A nasopharyngeal swab was antagonistic for terrible acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time reverse transcription-polymerase concatenation reaction. Serum IgM antibodies for SARS-CoV-2 were detected, indicating an antibody effect to the BBIBP-CorV vaccine. 

Initially, the diligent had numbness successful some legs, but precocious limbs and cranial nerves were spared. At that time, the differentials were GBS and different causes of acute predominantly sensory peripheral neuropathy, specified arsenic paraproteinemic and paraneoplastic neuropathy. However, with the accelerated symmetrical engagement of precocious limbs and bilateral little centrifugal neuron facial nervus palsy, a non-length-dependent polyradiculopathy specified arsenic GBS was considered much likely. With the fixed objective representation of bifacial weakness, paresthesia and hyporeflexia pursuing the vaccination and with supportive CSF and nervus conduction tests, the bifacial weakness with paresthesia (BFP) variant of GBS was diagnosed according to the National Institute of Neurological Disorders and Stroke criteria for GBS [7]. 

He was admitted to the high-dependency portion for observation, and objective parameters were monitored with prophylaxis for heavy venous thrombosis. Intravenous immunoglobulin (IVIG) was fixed astatine a dose of 0.4g/Kg for 5 days. We conservatively treated hyponatremia owed to SIADH with the regularisation of fluid intake to 1000ml per time for 3 days, with improvement.

After IVIG, the progression of neurological symptoms stopped, and bilateral facial weakness was contiguous connected discharge. The diligent was advised not to instrumentality the 2nd dose of the BBIBP-CorV. The diligent gradually improved implicit 3 weeks, and neurological symptoms resolved fully. He is presently progressive and successful bully health.

COVID-19 vaccination prevents death. In Sri Lanka, 5 antithetic types of vaccinations are presently successful use. BBIBP-CorV, developed by the Beijing Institution of Biological Products, is the astir predominant vaccine utilized successful Sri Lanka. It is an inactivated full microorganism vaccine with an efficacy of 79% against symptomatic COVID-19 corruption and hospitalization [8]. 

COVID-19 vaccinations person been linked to terrible adverse events. Vaccine-induced immune thrombocytopenic thrombosis was identified pursuing the adenovirus viral vector vaccines, peculiarly with ChAdOx1-S [9]. Myocarditis was recognized aft the mRNA vaccines [10]. However, terrible adverse events were not reported aft BBIBP-CorV [11].

GBS is simply a peripheral nervus illness owed to immunological sequela from erstwhile respiratory, gastrointestinal, bacterial, oregon viral infection. GBS has been linked to immunizations [12]. Pathophysiologically, antibodies produced by a vaccine could cross-react with the macromolecule recovered successful the myelin sheath of peripheral neurons [13].

In a caller systematic reappraisal of station COVID-19 vaccination with GBS, 88 patients were identified, and ChAdOx1-S was the associated vaccine successful 59%, followed by BNT162b2 (22.7%) [14]. In 79.5% of the cases, GBS occurred pursuing the archetypal dose of vaccination [14]. GBS developed successful six patients aft the inactivated BBIBP-CorV [5,15,16]. Four presented pursuing the archetypal dose, 1 aft the second, and the different aft the 3rd booster dose. Three had classical sensorimotor GBS, and the others had axenic centrifugal variant GBS. Three patients had GBS with the electrophysiological subtype of acute centrifugal axonal neuropathy, 2 had the acute centrifugal and sensory axonal neuropathy (AMSAN), and the different had the acute inflammatory demyelinating polyneuropathy (AIDP) subtype. The BFP variant of GBS was seen successful 15.9% of the patients aft COVID-19 vaccination [14], portion it is mostly seen successful little than 5% of different GBS patients [7]. The astir communal electrophysiological subtype of GBS pursuing COVID-19 vaccination was AIDP, which was seen successful 43.2%, and AMSAN was seen successful 10.2% [14]. 

Our diligent experienced bilateral symmetric little extremity numbness 18 days aft receiving the archetypal dose of inactivated SARS-CoV-2 vaccine, BBIBP-CorV and subsequently developed bifacial weakness with nary limb weakness. In a 2009 retrospective lawsuit investigation of 22 patients with the BFP variant of GBS, lone 4 patients had limb weakness, and 14 had demyelination [17]. A 2022 scoping reappraisal of post-COVID-19 vaccination recovered 18 patients with a BFP variant [18]. Out of 13 disposable NCSs, 5 had demyelination. Our diligent had electrophysiological information suggestive of focal segmental demyelinating sensory and centrifugal polyneuropathy.

Prominent bifacial weakness with paresthesia successful the little limbs successful our diligent could constituent to a chiseled objective signifier of GBS aft COVID-19 vaccinations. However, nary BFP variant of GBS was reported aft the BBIBP-CorV vaccine. He had SIADH associated with GBS, a known relation of GBS and is an indicator of mediocre prognosis [19].

Aside from the temporal narration and the deficiency of anterior respiratory oregon diarrheal illness, determination is nary important impervious that the BBIBP-CorV caused GBS. More probe with effectual postvaccination surveillance systems is required to found causation. The deficiency of different lawsuit reports of GBS oregon different neurological after-effects of the BBIBP-CorV vaccine successful Sri Lanka whitethorn beryllium owed to the inadequate surveillance strategy to observe adverse effects aft immunization. It is peculiarly existent for vaccines specified arsenic BBIBP-CorV, administered chiefly successful countries with mediocre grounds keeping.