Guillain-Barré Syndrome presenting as facial diplegia after COVID-19 vaccination: a case report

Rossetti, Arianna; Gheihman, Galina; O'Hare, Meabh; Kosowsky, Joshua M.

BACKGROUND: Guillain-Barré Syndrome (GBS) is a rapidly progressive immune-mediated polyneuropathy often associated with an antecedent infectious illness or vaccination. The classic presentation of GBS is characterized by ascending limb weakness and numbness with loss of reflexes. However, atypical variants involving the face and arms or with purely sensory symptoms also exist. In up to 30 percent of cases, GBS progresses to respiratory failure, with patients requiring mechanical ventilation. CASE REPORT: We report a case of atypical GBS occurring after COVID-19 vaccination in an otherwise healthy 38-year-old male. The patient's clinical presentation was characterized by bilateral hand and foot paresthesias, dysarthria, bilateral facial weakness, and an absence of classic ascending limb weakness. Albuminocytological dissociation within the cerebrospinal fluid was suggestive of GBS. The patient received intravenous immunoglobulin (IVIG) therapy with modest improvement in his symptoms at the time of the patient's discharge from the hospital. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? Patients with GBS are at risk for life threatening complications including respiratory failure requiring mechanical ventilation. It is critical for Emergency physicians to be aware of the manifold presentations of GBS for early recognition and treatment. This may be of particular importance in the context of a worldwide vaccination campaign in response to the COVID-19 pandemic.