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[新型冠状病毒肺炎疫苗接种后米勒-费希尔/吉兰-巴雷重叠综合征]

[Miller-Fisher/Guillain-Barré overlap syndrome following COVID-19 vaccination].

作者信息

Atzin-Vela Gil Arturo, Monroy-Parra Celeste Araceli, González-Rodríguez Carlos Humberto

机构信息

Instituto Mexicano del Seguro Social, Hospital General de Zona No. 1, Servicio de Medicina Interna. Tepic, Nayarit, México.

Instituto Mexicano del Seguro Social, Centro Médico Nacional de Occidente, Hospital de Especialidades "Lic. Ignacio García Téllez", Servicio de Nefrología. Guadalajara, Jalisco, México.

出版信息

Rev Med Inst Mex Seguro Soc. 2024 May 6;62(3):1-7. doi: 10.5281/zenodo.10998949.

Abstract

BACKGROUND

Anti-GQ1B syndrome includes a group of diseases characterized by antibody-mediated polyneuropathy. Guillain Barre syndrome (GBS) and the Miller-Fisher syndrome (MFS) have been related to COVID-19 vaccine application.

CLINIC CASE

48-year-old man, with history of Pfizer-BioNTech vaccination against COVID-19, 5 days prior to the symptoms, who assisted to the Emergency room with blurred vision and diplopia; adding dysarthria, facial diplegia and left upper limb weakness after 48 hours. In his first evaluation it was found ophthalmoplegia, facial diplegia, decreased gag reflex, weakness of thoracic limbs, bilateral trapezius muscle and areflexia. Serum studies and nuclear magnetic resonance of the brain were performed without alterations. It was complemented with IgG anti-ganglioside GQ1b antibodies with a positive result. Once the diagnosis was confirmed, treatment was started with immunoglobulin calculated at 2 g per kg for 5 days. The patient was discharged once the immunoglobulin was administered with evaluation at 2 months without ataxia, ophthalmoplegia, areflexia and weakness.

CONCLUSIONS

Following the documented reports of GBS and its variants secondary to vaccination, neurological side effects have been catalogued as being of great importance. Therefore, the reported case can be used as a point of reference to consider this clinical spectrum as a differential diagnosis in patients with post-vaccination neurological symptomatology.

摘要

背景

抗GQ1B综合征包括一组以抗体介导的多发性神经病为特征的疾病。格林-巴利综合征(GBS)和米勒-费希尔综合征(MFS)与新冠疫苗接种有关。

临床病例

一名48岁男性,有辉瑞-BioNTech新冠疫苗接种史,症状出现前5天,因视力模糊和复视到急诊室就诊;48小时后出现构音障碍、面瘫和左上肢无力。首次评估发现有眼肌麻痹、面瘫、咽反射减弱、肢体无力、双侧斜方肌麻痹和反射消失。血清学检查和脑部核磁共振检查均无异常。补充检测抗神经节苷脂GQ1b抗体IgG,结果呈阳性。确诊后,开始使用免疫球蛋白治疗,剂量为每千克2克,持续5天。给予免疫球蛋白治疗后患者出院,2个月后评估时无共济失调、眼肌麻痹、反射消失和无力症状。

结论

继接种疫苗后发生GBS及其变异型的文献报道之后,神经副作用已被列为极为重要的情况。因此,所报告的病例可作为一个参考点,将这一临床谱视为疫苗接种后出现神经症状患者的鉴别诊断依据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7385/12259147/a7e4b6379b29/04435117-62-3-e5504-f001.jpg

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