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Disparities in the incidence, prevalence, and morbidity and mortality rates of many respiratory diseases are evident among ethnic groups. Biological, cultural and environmental factors related to ethnicity can all contribute to the differences in respiratory health observed among ethnic minority groups, but the inequalities observed are most commonly due to lower socioeconomic position. People who migrate within a country or across an international border may experience an improvement in respiratory health associated with improvements in socioeconomic position. However, migrants may also experience worse health outcomes in destination countries, as they are faced by barriers in language and culture, discrimination, exclusion and limited access to health services. While some high-quality studies investigating ethnicity and respiratory health are available, further research into ethnic differences is needed. Improving the recording of ethnicity in health records, addressing barriers to accessing respiratory healthcare and improving cultural literacy more generally are some of the ways that inequalities can be tackled.Copyright © ERS 2023.
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Introduction: Hyperthyroidism is known to increase catabolism of vitamin-K-dependent clotting factors (II, VII, IX, X) and increase the response of vitamin K antagonists, usually warfarin. Primary biliary cirrhosis (PBC) has been associated with thyroid dysfunction (TD), especially with autoimmune thyroid disease. In the below case, a patient with known PBC on warfarin is found to have severely elevated INR related to new-onset hyperthyroidism with clinical consequences of hemorrhage including upper GI bleed. Case Description/Methods: A 64-year-old female with PBC and antiphospholipid antibody syndrome on warfarin was admitted for hemorrhagic epiglottitis requiring emergency intubation and supratherapeutic INR. Her PBC was diagnosed as stage II on biopsy 23 years ago and has remained clinically stable on ursodiol therapy. On presentation, the patient was tachycardic, tachypneic, and had O2 saturations <90% on HFNC prior to intubation. Physical exam significant for larger goiter with diffuse upper airway swelling. She was admitted and found to have COVID-19 infection, INR .16.0 and PT>200.0 (limit of lab), WBC of 22.8, and lactate of 2.5. LFTs WNL aside from albumin of 2.0. TSH was <0.0017 (limit of lab) and free T4 of 3.4, free T3 of 5.3. TSH receptor antibody (TRAB) and thyroid stimulating immunoglobulin (TSI) levels were normal. Her last TSH was normal a year ago. CTA chest found a 5.7cm heterogeneous, partially calcified superior mediastinal mass consistent with multinodular thyroid goiter. Patient was initially given prothrombin complex concentrate and vitamin K with correction of INR over the following few days. She was extubated and started on methimazole. During the hospital course, she was found to have coffee ground emesis for which an EGD was done with findings of non-bleeding gastric ulcer (Forrest Class IIc) and LA Grade D esophagitis with adherent clot and bleeding for which hemostatic spray was applied. Patient was discharged a few days later following resumption of warfarin and on pantoprazole and methimazole. Discussion(s): The above case demonstrates a rare case of PBC and new-onset hyperthyroidism due to multinodular thyroid goiter causing significantly elevated INR in the setting of warfarin use with hospital course complicated by GI bleed. PBC is associated with TD - hyperthyroidism, hypothyroidism, and thyroid cancer. Hyperthyroidism is less commonly associated with PBC compared to other TDs but should be considered especially with a finding of elevated INR.
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Background: SARS-CoV-2 evokes vigorous humoral immune responses which includes production of virus-specific antibodies of the immunoglobulin IgM, IgG & IgA isotypes. Seroconversion & production of detectable antibodies usually occurs within 20 days of symptom onset, while the kinetics of their production is variable. IgA is the major antibody class in mucosal membranes which plays an important role in SARS-CoV-2 infections. It's response in the early stage of the disease seems to be more pronounced than IgM. Objective(s): To detect the presence of serum IgA antibody response against Spike Receptor Binding Domain & Nucleoprotein of SARSCoV- 2 in naturally infected individuals as well as vaccinated individuals. Material(s) and Method(s): Confirmed RT-PCR Covid positive serum samples were tested by in-house developed SRBD IgA ELISA & N protein IgA ELISA of SARS-CoV-2. The subjects were classified according to the post onset of disease date. Serum samples of vaccinated individuals (Covishield & Covaxin) were assessed to compare IgA response. Result(s): Our results suggest a linear trend in the level of IgA antibody response POD 8 onwards in natural infection. In vaccinated individuals Covaxin groups exhibits a prominent increase in the IgA response in comparison to Covisheld. Conclusion(s): IgA might play an important role in assessing the immune status of SARS-CoV-2 infected patients. This study suggests that IgA antibody act as a promising immunological marker for vaccine study.
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Case Report: A 28 year old male with a past medical history of hypothyroidism and positive ANA presented to an outpatient dermatology clinic with a diffuse pruritic rash two weeks after the administration of his first Moderna COVID booster vaccine. He denied any other accompanying symptoms such as fever or chills as well as any similar rashes to prior doses of the Moderna COVID vaccine. The rash consisted of pink erythematous minimally scaly papules, thin plaques and patches involving the left and right dorsal hands, forearms, wrists, face, neck and left shoulder. The remainder of the patient's skin including the bilateral lower extremities, the eyelids, conjunctiva and oral mucosa was clear. The patient denied any similar rashes in the past. The patient denied any allergies to medications, or food or environmental allergies. He denied any notable contact allergen exposures, including to soaps, lotions, and cosmetic products. The patient also denied any significant family history or past surgical history. The patient was on Armour Thyroid for hypothyroidism and testosterone for low levels since age eighteen. The patient was started on cetirizine 10 mg once daily for the rash with minimal improvement. Autoimmune workup for the rash was notable for an elevated anti-RNP and as the patient's past medical history included Raynaud's phenomenon and ANA positivity for ten years, the patient was diagnosed with mixed connective tissue disease (MCTD). Autoimmune conditions can often have an indolent course, where symptoms progressively develop and worsen. MCTD is an autoimmune overlap syndrome that can consist of the following three connective tissue diseases: systemic lupus erythematosus, scleroderma, and polymyositis. Millions of individuals across the world are receiving COVID vaccines to protect themselves and members of their community, and it is of utmost importance that we continue to investigate adverse events. Although of low incidence, these rare effects have the ability to impact large numbers of people within both healthy and immunocompromised populations. It is critical that we examine and document them in a rigorous manner, to ensure safe vaccine delivery and reassure the public about vaccine safety overall.
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Background: From September 2021, Health Care Workers (HCWs) in Wales began eceiving a COVID-19 booster vaccination. This is the first dose beyond the primary vaccination schedule. Given the emergence o. new variants, vaccine waning vaccine, and increasing vaccination hesitancy, there is a need to understand booster vaccine uptake and subsequent breakthrough in this high-risk population. Methods: We conducted a prospective, national-scale, observational cohort study of HCWs in Wales using anonymised, linked data from the SAIL Databank. We analysed uptake of COVID-19 booster vaccinations from September 2021 to Februari 2022, with comparisons against uptake of the initial primary vaccination schedule. We also analysed booster breakthrough, in the form of PCR-confirmed SARS-Cov-2 infection, comparing to the second primarJ dose. Cox proportional hazard models were used to estimate associations for vaccination uptake and breakthrough regarding staff roles, socio-demographics, household composition, and other factors. Results: We derived a cohort of 73,030 HCWs living in Wales (78% female, 60% 18-49 years old). Uptake was quickest amongst HCWs aged 60 + years old (aHR 2.54, 95%Cl 2.45-2.63), compared with those aged 18-29. Asian HCWs had quicker uptake (aHR 1.18, 95%Cl 1.14-1.22), whilst Black HCWs had slower uptake (aHR 0.67, 95%Cl 0.61-0.74), compared to white HCWs. HCWs residing in the least deprived areas were slightly quicker to have received a booster dose (aHR 1.12, 95%Cl 1.09-1.15), compared with those in the most deprived areas. Strongest associations with breakthrough infections were found for those living with children (aHR 1.52, 95%Cl 1.41-1.63), compared to two-adult only households. HCWs aged 60+ years old were less likely to get breakthrough infections, compared to those aged 18-29 (aHR 0.42,<br />95%CI 0.38-0.47). Conclusion: Vaccination uptake was consistently lower among black HCWs, as well as those from deprived areas. Whilst breakthrough infections were highest in households with children. creativecommons.org/licenses/by/4.0/).<br />(c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license
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Background: Persisting breathlessness after COVID-19 infection is common and debilitating. We aimed to characterise and identify risk factors for patients with persistent breathlessness following COVID-19 hospitalisation. Method(s): PHOSP-COVID is a multi-centre prospective cohort study of UK adults hospitalised for COVID-19. Clinical data were collected during hospitalisation and at a research visit. Breathlessness was measured by a numeric rating scale of 0-10. We defined post-COVID breathlessness as an increase in score of 1 or more compared to the preCOVID-19 level. Multivariable logistic regression was used to identify risk factors. Result(s): We included 1,226 participants (37% female, median age 59 years, 22% mechanically ventilated). At a median five months after discharge, 50% reported post-COVID breathlessness. Risk factors for post-COVID breathlessness were socio-economic deprivation (adjusted odds ratio, 1.67;95% confidence interval, 1.14-2.44), pre-existing depression/anxiety (1.58;1.06-2.35), female sex (1.56;1.21-2.00) and admission duration (1.01;1.00- 1.02). Black ethnicity (0.56;0.35-0.89) and older age groups (0.31;0.14-0.66) were less likely to report post-COVID breathlessness. Post-COVID breathlessness was associated with worse performance on the shuttle walk test and forced vital capacity, but not with obstructive airflow limitation. Conclusion(s): Half of this national cohort of patients hospitalised for COVID-19 experienced persistent breathlessness at follow up. The risk factors identified for post-COVID breathlessness should inform mechanistic work to understand causal processes and develop future interventions to improve outcomes in this growing population.
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The COVID-19 pandemic changed everything, especially marketing, leading to increased digital usage. Social media allows faster connectivity among people and gives marketers new pathways to engage with consumers. The lockdown dramatically reduced economic activity by numbers that are worth understanding. This study examines the numerous aspects contributing to the consumer's favorable opinions toward their social commerce intents and behavior during the COVID-19 pandemic. Using SEM, the data examination of 297 respondents established that applying the social support theory and the unified theory of acceptance and use of technology (UTAUT) model to the proposed theoretical framework is significantly associated with social commerce intentions. The results state that all the direct hypotheses have been supported, confirming that social support, performance expectancy, effort expectancy, offline subjective norms, and online subjective norms are significantly associated with social commerce intentions. The results also indicated that Information Technology Infrastructure (ITI) moderated social support, performance expectancy, effort expectancy, and online subjective norms. © 2022 Korean Scholars of Marketing Science.
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The COVID-19 pandemic changed everything, especially marketing, leading to increased digital usage. Social media allows faster connectivity among people and gives marketers new pathways to engage with consumers. The lockdown dramatically reduced economic activity by numbers that are worth understanding. This study examines the numerous aspects contributing to the consumer's favorable opinions toward their social commerce intents and behavior during the COVID-19 pandemic. Using SEM, the data examination of 297 respondents established that applying the social support theory and the unified theory of acceptance and use of technology (UTAUT) model to the proposed theoretical framework is significantly associated with social commerce intentions. The results state that all the direct hypotheses have been supported, confirming that social support, performance expectancy, effort expectancy, offline subjective norms, and online subjective norms are significantly associated with social commerce intentions. The results also indicated that Information Technology Infrastructure (ITI) moderated social support, performance expectancy, effort expectancy, and online subjective norms.
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Aim: The purpose of this research is to identify if the COVID-19 positive result correlates with audiovestibular symptoms. Method(s):This researchaimed to evaluate the differences in hearing, hyperacusis, tinnitus and dizziness/rotatory vertigo that was experienced by those COVID-19 patients who were hospitalized and non-hospitalized during and after the severe phase of this pandemic in comparison to those that were observed by non-COVID-19 patients who served as controls. The research found that there was a total of 300 studied patients of COVID-19, out of which 150 were severe and required hospitalization, and 150 were moderate and could be treated at home. The control group consisted of 267 persons, of whom 32 had been hospitalized for an illness that was not COVID-19, and an additional 85 worked in hospital settings. Result(s):Eight percent of COVID-19 patients had hearing loss and/or tinnitus. The difference between moderate and severe cases is not significant. Tinnitus disappeared in 2% of cases following the acute phase. When comparing patients and controls, neither hearing loss nor tinnitus was significantly different. On the other hand, five percent of people in the COVID-19 groups reported experiencing rotatory vertigo, whereas only one percent of people in the control group did so. This disparity was significant. Conclusion(s): When comparing cases of varying severity, we find no evidence that COVID-19 puts a severe effect on tinnitus or hearing during the critical phase or after recovery. On the other hand, rotatory vertigo, which may have roots in the vestibular system, maybe a clinical symptom of COVID-19. Copyright © 2022, Anka Publishers. All rights reserved.
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Varicella pneumonia is a serious complication of varicella infection. It occurs more often in adults than in children, although it is now infrequently seen since the introduction of the chickenpox vaccines. In immunocompetent adults, varicella pneumonia has a reported incidence of about 1 in 400 cases of varicella infection and it also carries significant mortality. Here, we report a case of varicella pneumonia in a young male who was immunocompetent and had no comorbidities. This case teaches us to be always careful and thorough with our clinical assessment and to think about the alternative etiologies for the cause of atypical pneumonia even during the times of the COVID-19 pandemic and not get swayed by the sheer numbers of coronavirus infections.
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A global pandemic of Coronavirus appeared in December 2019 in Wuhan and spread globally. The objective behind the study was to find out the impact of COVID-19 on mental status and quality of life of physical therapists of Pakistan. This cross-sectional survey was carried out from August 2020 to January 2021. Data was collected online and personally from teaching and practicing physiotherapists working in universities and in departments of rehabilitation sciences of hospitals of Islamabad and Rawalpindi. A sample of 110 physiotherapists was selected through non-probability convenience sampling. Standardized questionnaires including Depression Anxiety and Stress Scale (DASS-21), World Health Organization-Quality of Life Questionnaire (WHOQOL-BREF) and Impact of Event Scale-Revised (IES-R) were used to assess depression, anxiety, stress, fear and quality of life. Out of 110 physiotherapists, 48 were males and 62 were females. Through DASS-21, it was assessed that the prevalence of psychological distress was 40.0%, anxiety was 57.3% and depression was 40%. Scores on all four sub-scales of WHOQOL depicted that COVID-19 also impacted the quality of life of physiotherapists including physical, psychological, social and environmental health related quality of life. Similarly, through IES-R, it was assess that 35.5% physiotherapists were having mild to severe level of fear regarding COVID-19. This study concludes us that COVID-19 has a great impact on mental health and quality of life of physiotherapists during this pandemic. Copyright © Nova Science Publishers, Inc.
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IntroductionVitamin D deficiency associates with susceptibility to COVID-19 and other acute respiratory infections (ARI).ObjectiveTo determine whether a ‘test-and-treat’ approach to vitamin D replacement in the general population reduces incidence of COVID-19 or other ARI.MethodsWe randomly assigned 6200 UK adults to receive an offer of a postal vitamin D test with postal provision of a 6-month supply of higher-dose vitamin D (3200 IU/d, n=1550) or lower-dose vitamin D (800 IU/d, n=1550) to those with 25(OH)D <75 nmol/L vs no offer of vitamin D testing or supplementation (n=3100). The primary outcome was the proportion of participants experiencing at least one test- or doctor-confirmed ARI of any cause at 6 months. Secondary outcomes included incidence of COVID-19.Results2958/3100 adults randomised to intervention accepted the offer of testing, of whom 2690 (90.9%) had 25(OH)D <75 nmol/L and received vitamin D supplements (1356 higher-dose, 1334 lower-dose). 72 adults in the higher-dose offer group, 86 in the lower-dose offer group and 132 in the no offer group experienced at least one ARI of any cause during follow-up (odds ratio [OR] for higher-dose vs. no offer 1.05, 95% CI 0.78–1.40;OR for lower-dose vs. no offer 1.27, 0.96–1.68). COVID-19 was diagnosed in 32 adults in the higher-dose offer group, 48 in the lower-dose offer group and 68 in the no offer group (OR for higher-dose vs. no offer 0.90, 0.59–1.37;OR for lower-dose vs. no offer 1.37, 0.94–1.99).ConclusionsIn adults with a high baseline prevalence of vitamin D insufficiency, a test-and-treat approach to vitamin D replacement did not reduce risk of all-cause ARI or COVID-19.Please refer to page A209 for declarations of interest related to this .
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SESSION TITLE: Dyspne Mysteries SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Anti-synthetase (AS) syndrome is characterized by interstitial lung disease (ILD), arthritis, myositis, fever, or Raynaud's phenomenon in the presence of an AS autoantibody (1). At least 70% of patients with AS syndrome develop ILD (2), and it represents the major cause of mortality in these patients with a 10 year survival rate of 73%. In a small cohort study, the anti-PL-12 antibody subtype was found to be strongly associated with ILD (3). CASE PRESENTATION: A 35 year old female with a history of tobacco use disorder presented to the hospital with three months of recurrent subjective fevers, non-productive cough, and dyspnea on exertion. She denied arthralgias, muscle weakness and hemoptysis. She initially presented to her primary care physician with these symptoms and was prescribed amoxicillin for streptococcal pharyngitis. The patient continued to be symptomatic and was treated empirically for COVID-19 pneumonia twice despite two negative COVID-19 tests and without any significant clinical improvement in her respiratory status. On admission, she was febrile, tachycardic, and had a new oxygen requirement with bilateral coarse breath sounds on exam. She had no leukocytosis and her COVID-19 test was negative. CT angiography of the chest showed extensive mixed reticular and airspace opacities with peribronchial predilection and peripheral sparing (figure 1). A bronchial alveolar lavage was notable only for neutrophilia (19%) and eosinophilia (4%). Rheumatological workup revealed elevated rheumatoid factor, positive antinuclear antibody (1:40), weakly positive anti–Sjögren's-syndrome-related antigen A antibody (50 AU/ml), undetectable anti-Jo-1 antibody and positive anti-PL-12 antibody. Pulmonary function testing revealed a TLC of 40% and DLCO of 28%, consistent with a restrictive pattern. Considering the patient's organizing pneumonia, positive antibodies, and findings of "mechanic's hands,” the patient was diagnosed with anti-synthetase syndrome with ILD. She was started on oral prednisone and mycophenolate mofetil. On follow-up, she was noted to have symptomatic improvement and stable hypoxia without clinical signs of disease progression. DISCUSSION: During the coronavirus pandemic, the resemblance of COVID-19 pneumonia to other diseases, in the absence of conscious suspicion for other etiologies, can lead to anchoring and availability bias thereby delaying diagnosis and appropriate treatment. Additionally, anti-synthetase syndrome should be considered in the differential diagnosis of ILD even in the absence of arthritis and myositis, as respiratory symptoms are often the first presenting signs. CONCLUSIONS: Increased responsibility is required of diagnosticians to exercise due diligence and active recognition of COVID availability and anchor bias to avoid missing crucial diagnoses. Reference #1: Cojocaru, Manole, Inimioara Mihaela Cojocaru, and Bogdan Chicos. "New insights into antisynthetase syndrome.” Maedica 11.2 (2016): 130. Reference #2: Marco, Joanna L., and Bridget F. Collins. "Clinical manifestations and treatment of antisynthetase syndrome.” Best Practice & Research Clinical Rheumatology 34.4 (2020): 101503. Reference #3: Kalluri, Meena, et al. "Clinical profile of anti-PL-12 autoantibody: cohort study and review of the literature.” Chest 135.6 (2009): 1550-1556. DISCLOSURES: No relevant relationships by Mario Flores No relevant relationships by David Jackson No relevant relationships by Lisa Saa No relevant relationships by Abu Baker Sheikh
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SESSION TITLE: Trainees: Mental Well-Being and Performance SESSION TYPE: Original Investigations PRESENTED ON: 10/16/22 10:30 am - 11:30 am PURPOSE: Mental health amongst house staff is poorly understood and at the forefront of many discussions regarding medical education and medical training. The COVID-19 pandemic which reached the United States in 2020, provided a novel situation which many house staff were unaccustomed. Few studies have been performed to assess mental health of house staff in relation to this pandemic. We would like to assess and study the prevalence of post-traumatic stress disorder (PTSD), anxiety, and depression in house staff during the COVID-19 pandemic METHODS: House staff in academic institution were invited to complete a survey anonymously via email from November 2021-January 2022. The survey was a compilation of 3 separate questionnaires: PCL-5 evaluating for PTSD, DASS-21 assessing depression, anxiety, and stress, and GAD-7 assessing anxiety. Scores were reported in mean and standard deviation. Prevalence of each disease was reported in frequency and percentage. T-test was used to compare scores between primary team (internal medicine, emergency medicine (EM), family medicine, and pulmonary and critical care (PCCM)) and non-primary team, and the scores between exposed (Anesthesiology, EM, PCCM) and non-exposed groups. Chi-squared analysis was performed to compare the prevalence of each disease between primary/non-primary and highly exposed/non-exposed groups. RESULTS: 60 house staff from 10 departments responded to the survey. Departments were stratified into primary and non-primary team as well as highly exposed and non-exposed group. Highly exposed group had significant higher mean scores of PTSD (20.92±19.45 vs 11.03±12.31, p=0.02), DASS-21 – depression (13.83±11.16 vs 6.39±8, p=0.004), and DASS-21 - stress (15±11.27 vs 8.17±8.03 p=0.008) compared to non-exposed group. The prevalence of moderate to severe depression (15(62.5%) vs 9(25%) p=0.007), stress (11(45.83%) vs 6(16.67%) p=0.02), and anxiety (7(29.17%) vs 3(8.33%) p=0.03) are significantly higher in exposed group. For primary team, the mean scores and prevalence of each disease are higher than non-primary team, though these are not statistically significant. CONCLUSIONS: Mental health amongst house staff has been impacted by the COVID pandemic. Symptoms of PTSD, Depression, Stress, and Anxiety were noted amongst house staff in relation to the pandemic. Our study demonstrated a clear impact on house staff that were in highly exposed fields. CLINICAL IMPLICATIONS: With continued emphasis on wellness for house staff, early recognition of mental health difficulties will be ideal to promoting wellness. Understanding the implications of pandemics and other high volume clinical scenarios upon the mental health of house staff could aid in early interventions to promote resident wellness. As the COVID pandemic continues to ebb, further studies will need to be done to assess the long term implications of the pandemic on the mental health of medical professionals DISCLOSURES: No relevant relationships by Prangthip Charoenpong No relevant relationships by Anum Sheikh No relevant relationships by Najam Siddiqui
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Background and aims: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke, contributing to less than 1%. We report an unusual case of severe iron deficiency anaemia (IDA) causing CVST in a young woman with menorrhagia. Methods: Case report: A 40-year-old female with underlying anaemia presented with headache, right leg numbness and expressive dysphasia. She experienced massive menstrual bleeding prior to the symptoms onset on background of uterine fibroids. There was no history of contraceptive pills consumption, massive blood transfusion, COVID-19 infection or vaccination. Systemic review was unremarkable. Results: Blood investigations revealed haemoglobin of 4.5g/dl, MCV 52.3fL, platelet 657x1////////09/L and low ferritin level. Coagulation profile, connective tissue disease, thrombophilia screening, serum homocysteine and HIV test were normal. Computed tomography (CT) of the head showed left temporoparietal lobe infarct and left dural venous sinus thrombosis. CT venography revealed CVST within the distal left transverse sinus and the vein of Labbe. Pelvic ultrasound showed multiple uterine fibroids. She was warfarinised and had iron and red cell transfusion. She agreed to take progesterone-only pill and interval hysterectomy after gynaecological review. Discussion: CVST in association with IDA is rare in adults and is more prevalent in men. In IDA, hypercoagulability and venous stasis play a vital role in thrombus formation. One study found that IDA in women caused arachidonic acid-induced platelet dysfunction causing menorrhagia which is reversible with iron repletion. Conclusion: IDA is a rare cause of CVST but should be considered in the context of relevant history and blood tests.
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Objective: The COVID-19 vaccination has been shown to be effective at protecting against severe COVID-19 related symptoms and death. However, many people have reported side effects after receiving the vaccination. Majority of them are mild, nonspecific, and go away within a few days. A few of the side effects are serious. It is important for neurologists to be aware of fatal side effects for appropriate cares. We present an unusual presentation of Guillain-Barré syndrome (GBS) post COVID-19 vaccine, bilateral facial nerve paralysis preceded by significant weakness in the lower extremities. Background: NA Design/Methods: NA Results: A 66-year-old male presented with right facial weakness which later progressed to bilateral facial paresis with difficulty in swallowing. Sixteen days prior, he received the Johnson & Johnson COVID-19 vaccine. The patient also reported development of myalgia and highgrade fever two days after the vaccination. The brain MRI was negative for acute changes and subsequently, the patient developed bilateral lower extremity weakness. The lumbar MRI revealed evidence of diffuse enhancement and mild thickening of all the nerve roots of the cauda equina. A lumbar puncture was performed, and CSF analysis showed albuminocytologic dissociation. He was diagnosed with GBS, and responded to IV immunoglobuin infusions. Conclusions: GBS is a rare neurological disorder in which the immune system attacks nerves and can result in progressive muscle weakness, numbness, and pain. Adenovirus vector is listed as a rare side effect of COVID-19 vaccine. We highlight the importance of recognizing GBS as a potential side effect of the COVID-19 vaccination.