Sequential Bell's Palsy and Guillain-Barre Syndrome in a Child Following COVID-19 Vaccination: A Case Report

ABSTRACT

Case Diagnosis A 10-year-old boy with postvaccination Guillain-Barre Syndrome (GBS) and Bell's Palsy Case Description or Program Description A 10-year-old white Hispanic boy without significant past medical history presented to the emergency room (ER) with new right facial droop two weeks following his second dose of the Pfizer COVID-19 vaccine. He was diagnosed with Bell's Palsy and received a five-day course of steroids. He returned to the ER ten days later with a four-day history of bilateral lower extremity pain, weakness, and progressively worsening gait. His examination was notable for less than antigravity strength throughout the major muscle groups of both lower limbs, in which he also had impaired light touch sensation and areflexia. Setting(s) Pediatric unit of acute care hospital Assessment/Results: Cerebrospinal fluid analysis was notable for elevated protein levels. In the setting of areflexia in the bilateral lower limbs, a presumptive diagnosis of GBS was made and a 5-day course of intravenous immunoglobulin (IVIg) was initiated, with improvement. At time of discharge, he was able to ambulate independently without use of an assistive device. Discussion (relevance) Both GBS and Bell's palsy have been reported following vaccinations. This case is unique in that both occurred sequentially in a pediatric patient within 1 month of the second dose of the Pfizer COVID-19 vaccine. Conclusion(s) Neurological complications of the COVID-19 vaccine include both Bell's Palsy and GBS, which as in this case, may occur sequentially. Prompt initiation of IVIg, steroids, and rehabilitation may result in good recovery.