Guillain-Barré Syndrome of Facial Variant Post COVID-19 Vaccination: A Case Report

Abstract

Introduction: Guillain-Barré syndrome(GBS) is an autoimmune condition commonly triggered post-infection and/or post-vaccinationwith various vaccines,such as the influenza, measles-mumps-rubella, and meningococcal vaccines,when the antibodies generatedby the immune system react with gangliosides at nerve membranes.
Importance:Theearly recognition of GBS variants and immediate intervention with intravenous (IV) immunoglobulin or plasma exchange is recommended to prevent life-threatening complicationswith the development of respiratory muscle weakness.
Case presentation:A 34-year-old male patient presented to the Emergency Department at King Abdullah Medical Cityin Makkah, Saudi Arabia, with a sudden onset of perioral numbness and left facial weakness two weeks after he was vaccinated with the Pfizer COVID-19 vaccine.A brain MRI with IV contrast showed that the left trigeminal nerve was thickened, and the fascial nerve had a subtle enhancement, which could be related to the post-infection process. A GBSCOVID-19 variant was suspected due to recent vaccination history. Anti-ganglioside antibodies GD1b were positive, and cerebrospinal fluidanalysis showed a high white blood count,a high glucose level, and a very slight high protein level.The patient was hospitalized, received five doses ofIV immunoglobulin, and was discharged in good condition. Data were collected from the hospital’s electronic medical records, including clinical notes, radiological imaging, and laboratory investigations.
Conclusion: GBS diagnosis is a clinical diagnosis.Electrophysiological studies, CSF, and neuroimaging supportthediagnosis of GBS; however, recognizing the early symptoms and signs of GBSand recognizing patients at risk who need close monitoring and treatment of adverse events following vaccination with COVID-19 vaccinesarecrucial.Further vaccination may be warranted when the benefit outweighs the risk of adverse events following vaccinations.