Facial Diplegia as the Sole Manifestation of Post-Vaccination Guillain-Barre Syndrome: A Case Report and Literature Review

Abstract

Introduction: Recently, a large study concluded that certain brands of vaccines may increase the risk of Bell’s palsy and Guillain Barre Syndrome (GBS). As to whether vaccination after COVID-19 modify the risk of Bell’s palsy or GBS has not yet been studied. Case: Here we report a 35 years old COVID-19 survivor whom in less than 2 weeks after his second dose of inactivated SARS-CoV2 vaccine, developed bilateral facial nerve paralysis. In addition, he had hyperacusis, dysgeusia and decreased lacrimation without any signs of sensory and motor deficits in the limbs. His limb nerve conduction study (NCS) was unremarkable in contrast to bilaterally abnormal facial NCS and blink reflexes. Although he had negative anti-GM1 IgG and IgM antibodies, he has marked albuminocytologic dissociation, classic of acute inflammatory demyelinating polyneuropathy. Conclusion: To date, there were no similar case reports which published the occurrence of facial diplegia as sole manifestation of GBS in a post COVID-19 patient who recently completed vaccination. We believe that molecular mimicry, induced by magnified immune response from both COVID-19 and vaccination may have caused the symptom.

Facial Diplegia Complicating Anti-SARS-CoV-2 Vaccinations

“…We also disagree with the statement that a brainstem lesion was ruled out because it would lead to multiple cranial nerve lesions and limb weakness in addition to abnormal cranial imaging 1 . First, a cerebral CT-scan is not sufficient to rule out brainstem encephalitis.…”

“…With interest we read the article by Prado et al about a 35 years-old male who developed facial diplegia 10 days after the second dose of an anti-SARS-CoV-2 vaccination with an inactivated strain. 1 The patient was diagnosed with Guillain-Barre syndrome (GBS), subtype cranial nerve affection, and profited from steroids. 1 The study is promising but raises concerns that should be discussed.…”

“…1 The patient was diagnosed with Guillain-Barre syndrome (GBS), subtype cranial nerve affection, and profited from steroids. 1 The study is promising but raises concerns that should be discussed.…”

“…We disagree with the statement that the patient had isolated facial palsy. 1 The patient is described with tongue numbness, why it is conceivable that the sensory portion of the trigeminal nerve was additionally affected. Furthermore, the patient was described with dysphagia why it cannot be ruled out that the glossopharyngeal and the vagal nerves were affected as well.…”

“…Furthermore, the patient was described with dysphagia why it cannot be ruled out that the glossopharyngeal and the vagal nerves were affected as well. Furthermore, the pectoralis reflex, the bicpes tendon reflex and the brachioradialis reflex were hyporeflexic, 1 suggesting that peripheral nerve roots were additionally affected.…”