Abstract
We report the case of a 41-year-old previously well male who developed recurrent Guillain-Barre syndrome (GBS) following sequential COVID-19 vaccination and again after subsequent acute COVID-19 infection. While recurrent GBS is reported, monophasic courses predominate the literature with temporal associations to new viral illnesses or vaccinations. Notably with the world-wide viral and vaccine crisis, atypical forms of GBS have been reported particularly in association to COVID-19 vaccination. In this case, our patient had an onset of distal parasthaesias at three weeks following COVID-19 vaccination progressing proximally over the next two weeks. These symptoms eased and he proceeded with his second dose at the planned time interval. Unfortunately, one week following this vaccination he developed a recurrence of symptoms so severe they prompted presentation to an emergency department. At this time, he was diagnosed with GBS due to the clinical picture of distally progressive parasthaesias and hyporeflexia with cerebrospinal fluid albuminocytologic dissociation. He subsequently rapidly responded to a standard course of intravenous immunoglobulin. Following this initial treatment course, he suffered a recrudescence of symptoms following acute COVID-19 infection. These symptoms remained mild and have abated with now only residual intermittent tingling parasthaesias which no longer interferes with his daily function. There is a lack of evidence to support a causal relationship between COVID-19 vaccination and recurrent GBS however, this case raises the question of safety for future vaccination in these patients where initial diagnosis and subsequent relapse had temporal associations with exposure.
