Neurology Department, Habib Bourguiba Hospital, Sfax, Tunisia.
Pan Afr Med J. 2024 Feb 6;47:46. doi: 10.11604/pamj.2024.47.46.42455. eCollection 2024.
COVID-19 vaccination side effects have been increasingly reported, including new-onset autoimmune diseases such as chronic arthritis, thrombocytopenia, Guillain-Barré syndrome (GBS), and more recently chronic inflammatory demyelinating polyneuropathies (CIDP). Molecular mimicry and vaccine adjuvants appear to be important contributors to immune-mediated neuropathies. However, whether the link between the COVID-19 vaccine and these autoimmune disorders is coincidental or causal remains uncertain. We describe the ever-reported case of acute-onset CIDP following the Oxford/AstraZeneca vaccine in Tunisia. The patient is a 41-year-old man who presented with acute, worsening weakness of the four limbs. The symptoms appeared 15 days after his first dose of the AstraZeneca vaccine. The diagnosis of GBS was initially confirmed according to the clinical features, the albumino-cytological dissociation in the cerebrospinal fluid (CSF), and the electroneuromyography (ENMG) findings. Serum workup for all known infections associated with immune-mediated neuropathy was negative. The patient was treated with plasma exchange without initial improvement followed by aggravation of the symptomatology after an interval of four and a half months. Control ENMG showed signs of CIDP meeting the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) criteria of 2021. The patient was treated with maintenance intravenous immunoglobulin and oral corticosteroids. Neurological examination 3 months after discharge showed partial improvement. Worldwide, cases of demyelinating polyneuropathies post-COVID-19 vaccination are increasingly reported. The acute onset of CIDP might lead to a misdiagnosis of GBS. Awareness of this complication and distinction from GBS enables early relay with maintenance treatment to prevent relapses and severe complications. Post-COVID neuropathies are found to be more frequently linked to the AstraZeneca vaccine, however, temporal association does not confirm causal association.
COVID-19 疫苗接种的副作用越来越多，包括新出现的自身免疫性疾病，如慢性关节炎、血小板减少症、格林-巴利综合征（GBS），以及最近的慢性炎症性脱髓鞘性多发性神经病（CIDP）。分子模拟和疫苗佐剂似乎是免疫介导的神经病的重要因素。然而，COVID-19 疫苗与这些自身免疫性疾病之间的联系是偶然的还是因果关系尚不确定。我们描述了突尼斯一例在接种牛津/阿斯利康疫苗后急性发作的 CIDP 病例。患者是一名 41 岁男性，表现为四肢急性、逐渐加重的无力。症状出现在他第一次接种阿斯利康疫苗后 15 天。根据临床特征、脑脊液（CSF）中的蛋白细胞分离以及电神经肌图（ENMG）结果，最初确诊为 GBS。所有与免疫介导性神经病相关的已知感染的血清学检查均为阴性。患者接受了血浆置换治疗，但初始无改善，四个半月后症状加重。对照 ENMG 显示符合欧洲神经病学学会/周围神经学会（EAN/PNS）2021 年标准的 CIDP 迹象。患者接受了静脉免疫球蛋白维持治疗和口服皮质类固醇治疗。出院后 3 个月的神经学检查显示部分改善。全球范围内，COVID-19 疫苗接种后脱髓鞘性多发性神经病的病例越来越多。CIDP 的急性发作可能导致 GBS 的误诊。对此并发症的认识并与 GBS 区分开来，可尽早进行维持治疗以预防复发和严重并发症。发现 COVID-19 后神经病变与阿斯利康疫苗的关系更为密切，但时间关联并不能确认因果关联。
