Abstract
Introduction Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired autoimmune condition affecting the peripheral nerve and nerve roots. Vaccination for the SARS-CoV-2 virus has been associated with incident CIDP diagnoses, though the mechanism is unclear. We present a case of refractory CIDP following administration of the ChAdOx1 nCoV-19 vaccine and propose that vaccination unmasked a previously asymptomatic neuropathy.
Case A 79-year-old man presented with acute onset lower limb weakness and sensory disturbance 2 weeks after administration of the ChAdOx1 nCoV-19 vaccine. Clinical and neurophysiological assessments were consistent with acute inflammatory demyelinating polyneuropathy (AIDP). Despite early treatment with first line therapy, the patient experienced relapses over 5 months with incomplete recovery. A sural nerve biopsy in the acute setting showed changes consistent with chronic demyelination/remyelination. The patient improved following plasma exchange, rituximab, and bortezomib and was independently mobile on discharge.
Discussion The development of inflammatory neuropathy following vaccination is an established association. CIDP is a rare association with the ChAdOx1 nCoV-19 vaccine, typically presenting with acute neuropathy that proceeds to chronicity, as in our patient. In the present case, sural nerve biopsy showed findings consistent with chronic neuropathy although it was taken in the acute setting. We propose that the COVID-19 vaccine unmasked CIDP in a previously asymptomatic patient. A high index of suspicion and regular follow for those who develop neuropathy following vaccination is recommended.
