A Pediatric Case of Sensory Predominant Guillain-Barré Syndrome Following COVID-19 Vaccination

ABSTRACT

Objective: Increased data about potential adverse events following COVID-19 vaccination will contribute to a better-informed evaluation of the safety of the vaccines. Here, we describe a case of sensory predominant Guillain-Barré Syndrome (GBS) following administration of PfizerBioNTech vaccine in a 16-year-old female. Background: Over 3.58 billion people worldwide have received at least 1 dose of the COVID-19 vaccine. The concerns for GBS first arose with ChAdOx1 nCoV-19 (Oxford/AstraZeneca). More than 200 cases associated with the vaccine have been reported. Recently, Janssen/Johnson&Johnson vaccine was also reported to have a small but statistically significant increase in risk for GBS with an estimated absolute rate increase of 6.36 per 100,000 person-years in adults. Thus far, no studies have shown an association between Pfizer-BioNTech vaccine and GBS. Design/Methods: N/A Results: A previously healthy and athletic 16-year-old female presented to the emergency department with 3 weeks of ascending numbness and paresthesia of her bilateral lower and upper extremities. She received her second dose of Pfizer-BioNTech COVID-19 vaccine 2 days prior to symptom onset. On neurological examination, she had intact strength, absent reflexes, decreased sensation to pinprick, diminished vibratory sensation, and mild ataxia on toe and tandem walking. MRI study showed mild thickening and enhancement of the anterior and posterior spinal nerve roots of the cauda equina, consistent with GBS. With lumbar puncture, albuminocytologic dissociation was seen in CSF. Conclusions: Our patient presented with clinical signs, imaging, and lab findings most consistent with the diagnosis of GBS. Idiopathic or asymptomatic infectious causes of GBS cannot be completely ruled out;however, with the recent vaccination and absence of any other clinical signs or lab findings, the vaccine is most likely to be the trigger for our patient. To date, this is the first case reported of GBS in a pediatric patient after receiving the Pfizer-BioNTech vaccine.