Guillain-Barré Syndrome after Mrna-1273 Covid-19 Vaccine Booster in an Immunosuppressed Double Lung Transplant Recipient

ABSTRACT

Guillain-Barré Syndrome (GBS) is an immune-mediated neurological disorder with an estimated incidence of 1 to 2 per 100,000 person-years. GBS is characterized by progressive and symmetric ascending muscle weakness, areflexia, sensory symptoms, and dysautonomia. Antecedent infection or vaccination may trigger GBS;however, there are few reports of GBS after either mRNA-1273 (Moderna) or mRNA-BNT-162b2 (Pfizer-BioNTech) COVID-19 vaccines (1.21 and 1.05 GBS reports per million doses, respectively). A 2021 analysis of the Vaccine Safety Datalink found no increased risk of GBS after vaccination with either of the vaccines. We report a case of GBS after a third dose of mRNA-1273 in a lung transplant recipient (LTxR). A 38-year-old LTxR on standard 3-drug immunosuppression presented to clinic complaining of back pain 2 weeks after receiving a third dose of mRNA-1273. His pain was treated with analgesics;however, a week later he presented to the Emergency Department (ED) with worsening back pain, myalgias, and lower extremity weakness. Neurology was consulted and he underwent an extensive work-up including screening serologies for vasculitis and myasthenia gravis and blood tests for B12, folate, and creatinine kinase (CK) levels. Viral and bacterial infections were ruled out. A spinal MRI showed no evidence of nerve root enhancement;a lumbar puncture revealed albuminocytologic dissociation with a high protein level of 113 mg/dL and cell count of 1/uL. Autoimmune and paraneoplastic panels as well as oligoclonal bands were negative. He was diagnosed with GBS and completed a 5-day IVIG course which led to transient symptomatic improvement. Four weeks later, he reported to the ED in a wheel chair after multiple falls and an inability to stand or walk. His neurological exam showed symmetric ascending weakness of lower extremities that was worse distally, reduced hand-grip strength, and areflexia. Electromyography showed evidence of acute inflammatory demyelinating polyneuropathy, confirming the GBS diagnosis. An additional 2-day IVIG course and intensive outpatient physical therapy led to neurologic improvement. Although current data does not suggest an increased risk of GBS after mRNA COVID-19 vaccines, GBS should be considered in LTxRs who develop symmetric motor and sensory deficits after vaccination. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)