Matsumoto Kensuke, Morioka Tatsuki, Tokuda Katsuhiro, Arai Shoya, Matsuo Takuji, Shirasaki Ryosuke, Ooi Jun, Tashiro Haruko
Department of Hematology/Oncology, Teikyo University School of Medicine, Tokyo, Japan.
Department of Transfusion Medicine and Cell-processing, Teikyo University School of Medicine, Tokyo, Japan.
Clin Exp Vaccine Res. 2025 Jul;14(3):294-297. doi: 10.7774/cevr.2025.14.e26. Epub 2025 Jun 13.
The occurrence of Guillain-Barré syndrome (GBS) following coronavirus disease 2019 (COVID-19) vaccination have been documented; however, its pathogenesis remains unclear. We present a case of GBS associated with T-cell receptor (TCR) clonal rearrangement after COVID-19 vaccination. A previously healthy 60-year-old man developed fever, skin rash, general fatigue, and generalized urticaria after receiving his third vaccine dose (Spikevax, Moderna). No adverse events occurred after his first and second doses (COMIRNATY, Pfizer). Within 4 weeks of vaccination, the patient experienced progressive limb weakness and gait instability, and was referred to our hospital. Nerve conduction studies revealed increased distal latency, reduced compound muscle action potential amplitudes, decreased motor nerve conduction velocities, and diminished sensory nerve action potentials. Positron emission tomography-computed tomography showed systemic lymphadenopathy, splenomegaly, and increased splenic and bone marrow uptake. Bone marrow biopsy and peripheral blood analysis demonstrated TCR clonal rearrangement, which resolved by day 115 post-vaccination. Based on clinical progression, electrophysiological findings, and worsening neurological symptoms, a diagnosis of GBS was made. This case suggests that aberrant T-cell clonal expansion may contribute to GBS development following COVID-19 vaccination. To our knowledge, this is the first report describing TCR gene clonal rearrangement following COVID-19 vaccination.
2019冠状病毒病（COVID-19）疫苗接种后吉兰-巴雷综合征（GBS）的发生已有文献记载；然而，其发病机制仍不清楚。我们报告1例COVID-19疫苗接种后与T细胞受体（TCR）克隆重排相关的GBS病例。一名既往健康的60岁男性在接种第三剂疫苗（Spikevax，Moderna）后出现发热、皮疹、全身乏力和全身性荨麻疹。他接种第一剂和第二剂（COMIRNATY，辉瑞）后未发生不良事件。接种疫苗后4周内，患者出现进行性肢体无力和步态不稳，并被转诊至我院。神经传导研究显示远端潜伏期延长、复合肌肉动作电位幅度降低、运动神经传导速度减慢和感觉神经动作电位减弱。正电子发射断层扫描计算机断层扫描显示全身淋巴结肿大、脾肿大以及脾脏和骨髓摄取增加。骨髓活检和外周血分析显示TCR克隆重排，在接种疫苗后第115天得到缓解。根据临床进展、电生理结果和神经系统症状恶化情况，诊断为GBS。该病例提示异常的T细胞克隆扩增可能促成COVID-19疫苗接种后GBS的发生。据我们所知，这是第一份描述COVID-19疫苗接种后TCR基因克隆重排的报告。
