Guillain–Barré Syndrome due to COVID-19 Vero Cell Vaccination Associated with Concomitant COVID-19 Infection-induced ARDS and Treated Successfully by Therapeutic Plasma Exchange: A First Case Report from Vietnam

Abstract

Post-vaccination adverse reactions have been reported with varying symptoms and severity owing to research and production time pressures during the coronavirus disease 2019 (COVID-19) pandemic. In this article, we report a rare case of Guillain–Barré syndrome (GBS) in a patient with COVID-19 with acute respiratory distress syndrome (ARDS) after receiving Sinopharm's Vero Cell vaccine (China). The patient who was initially negative for COVID-19 was diagnosed with GBS based on paralysis that developed from the lower extremities to the upper extremities, as confirmed by cytoalbuminologic dissociation in the cerebrospinal fluid. The patient's condition worsened with ARDS caused by COVID-19 infection during the hospital stay, and SpO 2 decreased to 83% while receiving oxygen through a non-rebreather mask (15 l/min) on day 6. The patient was treated with standard therapy for severe COVID-19, invasive mechanical ventilation, and five cycles of therapeutic plasma exchange (TPE) with 5% albumin replacement on day 11 due to severe progression. The patient was weaned off the ventilator on day 28, discharged on day 42, and was completely healthy after 6 months without any neurological sequelae until now. Our report showed the potential of TPE for GBS treatment in critically ill patients with COVID-19 after COVID-19 vaccination.

A Response Letter to: Letter to the Editor Regarding “Anti-SARS-CoV-2 Vaccination Related Polyradiculitis Requires Early Diagnosis and Treatment to Improve the Outcome: Facts and Challenges During COVID-19 Pandemic”

“…However, we are unable to determine whether the poor progression of GBS during the early course of the disease was due to delayed treatment or concomitant SARS-CoV-2 infection. This notion has been discussed in our case report and has been considered as one of its limitations [ 2 ].…”

“…We were delighted to receive a letter [ 1 ] regarding the interests and limitations of the case report that we recently published in the Pulmonary Therapy journal [ 2 ]. In this case report, a 22-year old man with no significant past medical history developed quadriparesis with predominance in the lower limbs 2 weeks after his first dose of the coronavirus disease 2019 (COVID-19) inactivated vaccine (Vero Cell) [ 2 ]. The patient had no fever, cough, or other respiratory symptoms prior to admission.…”

“…However, as a result of disease progression and concomitant COVID-19 infection during hospitalization, the patient was transferred to the intensive care unit (ICU) and treated with mechanical ventilation, antibiotics to prevent nosocomial infection, intravenous corticosteroids, anticoagulation, and therapeutic plasma exchange (TPE) with 5% albumin replacement. Fortunately, the patient was weaned off the ventilator on day 28, discharged on day 42, and made a complete recovery 6 months later without any neurological sequelae [ 2 ]. The outcome of the reported patient was excellent considering the high mortality and morbidity of patients with severe and complicated COVID-19 during the fourth wave of the pandemic in 2021 in Vietnam.…”

“…Additionally, as with both this case report and our previously published report, the diagnosis of GBS could be consolidated by the elimination of alternative diagnoses [ 5 ]. In our case report, differential diagnoses such as compressive myelopathy, transverse myelitis, acute myelitis, or GBS due to other causes were excluded by a multidisciplinary specialist staff on the basis of laboratory testing and MRI (magnetic resonance imaging) [ 2 ]. Therefore, all the relevant comments presented in this letter to editor are very useful for strengthening the diagnosis of GBS in clinical practice [ 1 ].…”

“…Thirdly, as remarked by the letter’s author [ 1 ] who would like to know about the patient’s cerebral imaging to make sure that other motor deficits such as poor response to verbal stimuli, dysphagia, and chewing difficulty could not be due to brainstem encephalitis (Bickerstaff encephalitis) complicated by GBS [ 6 ]. In our case report, the patient was described to respond poorly to verbal stimuli because he exhibited peripheral motor deficit and that was not related to aphasia or dysarthria or due to impaired consciousness or cognition [ 2 ].…”