Age: 30.0
Sex: F
Vaccine: COVID19
Symptoms: CSF test, Cytomegalovirus test, Drug screen, Electrophoresis protein, Exposure during pregnancy
Clinical narrative: FACIAL DIPLEGIA VARIANT OF GUILLAIN-BARRE SYNDROME; FACIAL PARESIS; PARAESTHESIA; NEUROLOGIC SYMPTOMS; VACCINE EXPOSURE DURING PREGNANCY; LUMBAR PUNCTURE ABNORMAL; RASH; This spontaneous pregnancy report was received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1290037) via literature: Facial Diplegia Variant of Guillain-Barre Syndrome in Pregnancy Following COVID-19 Vaccination: A Case Report. Cureus. 2022 Feb 17; 14/2. This report concerned a 30 year old female of unspecified race and ethnic origin. The objective of this study was to describe Facial diplegia Variant of Guillain-Barre Syndrome in pregnancy following administration of COVID-19 vaccination. The patient's height, and weight were not reported. The patient's past medical history included: CMV (Cytomegalovirus) infection, and concurrent conditions included: depression. Her past medical history was notable for heterozygous factor V Leiden deficiency, not currently on treatment. The patient had no known allergies. Patient was right-handed, pregnant with gravida 1 and para zero. Patient was not currently on treatment. She had no obstetric issues. She had a normal gait with negative Romberg. The patient had no reported history of infection or signs of ongoing infection at the time of presentation. The date of the patient's last menstrual period and expected delivery date were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: unknown, expiry: unknown) dose was not reported, 1 total administered on 08-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included sertraline hydrochloride for depression. The patient reported an all-over body rash a week after the vaccine. Approximately 2 weeks later, she presented with neurological symptoms with left facial weakness, now with significant bifacial paresis and bilateral hand paresthesias concerning for Guillain Barre Syndrome which was confirmed on lumbar puncture (lumbar puncture abnormal). On an unspecified date in APR-2021, the patient presented to the emergency department (ED) with four days of bifrontal headache, new-onset left facial weakness, and loss of taste. The patient was 27 weeks pregnant at the time she presented to ED (coded as vaccine exposure during pregnancy). She had weakness of the upper and lower face, and both hyperacusis and dysgeusia on the left (coded as neurologic symptoms). The patient denied any antecedent infections, tick bites, surgical procedures involving her face or mouth, or health changes. She received vaccine two weeks prior to symptoms onset. On unspecified date she was hospitalized for unspecified days. She was discharged on prednisone taper and valacyclovir with a diagnosis of facial nerve palsy and instructed to pursue outpatient neurology follow up. Five days after the initial presentation, she developed facial diplegia with dysarthria, dysphagia and hand paresthesia, she returned to the emergency department with tachycardia, normotensive, and afebrile. On 27-APR-2021, the patient was diagnosed with the facial diplegia variant of Guillain-Barre Syndrome (GBS). Neurologic examination was notable for normal mental status, equal and reactive pupils, intact extraocular movements, decreased facial sensation, facial diplegia, and impaired taste. Her speech was dysarthric. Motor examination included normal strength and tone in the upper and lower extremities with sensory examination notable for decreased pinprick sensation in the hands and feet. Reflexes were present and symmetric throughout with down-going toes. She had a normal gait with negative Romberg. Cerebrospinal fluid (CSF) analysis was notable for zero nucleated cells, elevated protein count of 104.3 mg/dL, and glucose of 59 mg/dL. On an unspecified date, laboratory data (dates unspecified) included: Angiotensin converting enzyme (NR: 12 - 82) 17 U/L, Antinuclear antibody (NR: not provided) 1:40, CMV IgG antibody (NR: not provided) Positive, CMV IgM antibody (NR: not provided) negative, CSF (Cerebrospinal fluid) test (NR: not provided) no fungal growth with nucleated cell count 0, Red cell count-1 cell, Glucose-59 mg/dL, (herpes simplex virus by polymerase chain reaction (PCR),Varicella zoster PCR, Epsteinbarr virus by PCR-(Not detected), HbA1C (NR: not provided) 4.9 %, Hepatitis B surface antibody (NR: not provided) 128.82 (micro-international units per milliliter), Hepatitis B surface antigen (NR: not provided) not detected, Hepatitis C antibody (NR: not provided) negative, Human immunodeficiency virus syndrome (NR: not provided) not detected, Immunoglobulin A (NR: 70 - 470) 113 mg/dL, Immunoglobulin G (NR: 700 - 1600) 754 mg/dL, Immunoglobulin M (NR: 40 - 230) 101 mg/dL, Lumbar puncture (NR: not provided) abnormal, Elevated protein, Head magnetic resonance venography (MRV) found no evidence of acute dural venous sinus thrombosis., Magnetic resonance imaging (MRI) of the brain demonstrated craniovertebral junction tonsillar extension into the foramen magnum by 4-5 mm, consistent with a borderline Chiari 1 malformation but no other abnormalities. Nerve conduction studies (NR: not provided). A diffuse sensorimotor demyelinating polyneuropathy, normal strength and tone in the upper and lower extremities with sensory examination notable for decreased pinprick sensation in the hands and feet, Neurological examination (NR: not provided) normal mental status, equal and reactive pupils, intact extraocular movements, decreased facial sensation, facial diplegia, and impaired taste, dysarthria, nicotinamide (NR: not provided) 33 ng/mL, Alpha 1 globulin (NR: 0.10 - 0.30) 0.24 g/dL, Alpha 2 globulin (NR: 0.60 - 1) 0.84 g/dL, Gamma globulin (NR: 0.70 - 1.50) 0.60 g/dL, SARS-CoV-2 PCR test (NR: not provided) negative was done on two occasions five days apart , Serum albumin (NR: 3.6 - 4.9) 3.8 g/dL, Serum protein electrophoresis (NR: not provided) no discrete abnormal bands, Thyroid stimulating hormone (NR: 0.320 - 3.850) 2.830 (micro-international units per milliliter), Total protein normal (NR: 6 - 8.3) 5.8 g/dL, Treponema pallidum antibody (NR: not provided) Non-reactive, Urinalysis (NR: not provided) Urobilinogen less than 2 EU/dL with Specific gravity- 1.011, PH-7.0, Protein, Glucose, Ketones, Ketones, Bilirubin, Bilirubin, Nitrite all was negative, Urine drug screen (NR: not provided) Negative for all drug amphetamine, Benzodiazepines, Cocaine, Cannabinoids, Opiates, Oxycodone, Phencyclidine, Methadone metabolite, Barbiturate, Urine electrophoresis (NR: not provided) no abnormal proteins with (Albumin-0.01, Alpha-1 globulin -0.00, Alpha-2 globulin- 0.01, Beta globulin-0.01, Gamma globulin- 0.02)g/L, Vitamin B1 (NR: 8 - 30) 18 nmol/L, Vitamin B12 (NR: 211 - 911) 412 pg/mL, Vitamin B3 (NR: not provided) less than 20 ng/mL, and Vitamin B6 (NR: 2.1 - 21.7) 15.5 ng/mL, Vital capacity (NR: not provided) negative, Inspiratory capacity (NR: not provided) negative, Fetal monitoring (NR: not provided) negative assessments by obstetrics service, Cerebrospinal fluid protein increased (NR: not provided) 104.3 mg/dL, Lyme antibody was 0.39 LI, Ganglioside ASIALO GM 1 antibody, IgG (Immunoglobulin G), enzyme immunoassay (EIA) 1:100 (H), Ganglioside ASIALO GM 1 antibody, IgM (Immunoglobulin M ), EIA less than 1:16002, Ganglioside GD1A antibody, IgG, EIA less than 1:100, Ganglioside GD1A antibody, IgM, EIA less than 1:800, Ganglioside GQ1B antibody, IgG less than 1:100, GM 1 IgG, GM 1 IgG less than 1:800. Workup identified positive cytomegalovirus (CMV) IgG and negative CMV IgM consistent with prior CMV infection that would not explain her symptoms. The findings of facial diplegia occurring in a progressive manner with associated sensory symptoms coupled with the albuminocytologic dissociation in the CSF and electrodiagnostic findings are consistent with the facial diplegia variant of GBS. She was started on intravenous immunoglobulin (IVIG) at 2 g/kg after pretreatment with acetaminophen and diphenhydramine. She was monitored closely with testing for negative inspiratory force and vital capacity as well as regular fetal assessments by obstetrics service. She also received eye drops to treat dry eyes and was cleared for diet after speech and swallow evaluation. The patient had significantly improved dysphasia, dysarthria, and facial strength with IVIG. Additionally, her numbness began resolving, and her voice began returning to normal. Once she reached 28 weeks estimated gestational age, she received a RhoGAM shot with no complications. On an unspecified date, after 40 weeks and five days of gestational age, the patient gave birth to a healthy baby boy via normal spontaneous vaginal delivery with no complications. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The author emphasized that the patient presented after COVID-19 vaccination without preceding infection or other treatment linked with GBS, that does not by itself implicate the vaccine as a cause. We stress that temporal associations. We stress that temporal associations do not imply causality. Rather, we highlight this case to encourage additional large population-based studies to assess for any statistically significant correlations. COVID-19 vaccine is critically important in turning the tide against this pandemic, and we strongly recommend vaccination given the significant benefits. The patient fully recovered to baseline four weeks after presentation. The patient recovered from facial diplegia variant of Guillain-Barre syndrome, vaccine exposure during pregnancy, rash, lumbar puncture abnormal, facial paresis, paraesthesia, and neurologic symptoms on MAY-2021. This report was serious (Hospitalization Caused / Prolonged).  Additional information was received from health care professional via literature: Facial Diplegia Variant of Guillain-Barre Syndrome in Pregnancy Following COVID-19 Vaccination: A Case Report. Cureus. 2022 Feb 17; 14/2. on 16-MAR-2022. The following information was updated and incorporated into the case narrative: Literature reporter added, updated patient history and other pre-existing medical conditions, pregnancy details (para, gravida, outcome and gestation age) updated, laboratory data and treatment medications added, updated event term of Guillain-Barre Syndrome to facial diplegia variant of Guillain-Barre Syndrome, outcome of all events updated to recovered, narrative updated accordingly.; Sender's Comments: V1: This version updates :Literature reporter added, updated patient history and other pre-existing medical conditions, pregnancy details (para, gravida, outcome and gestation age) updated, laboratory data and treatment medications added, updated event term of Guillain-Barre Syndrome to facial diplegia variant of Guillain-Barre Syndrome, outcome of all events updated to recovered, narrative updated accordingly. Medical assessment comment updated for event RRT. 20210527982-COVID-19 VACCINE AD26.COV2.S-Vaccine exposure during pregnancy.. Follow-up received regarding Clinical Details. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS. Therefore, this event(s) is considered not related. 20210527982-COVID-19 VACCINE AD26.COV2.S- Facial diplegia variant of Guillain-Barre syndrome, Facial paresis, Lumbar puncture abnormal, Neurologic symptoms, Paraesthesia. Follow-up received regarding Clinical Details. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). Therefore, this event(s) is considered unassessable. 20210527982-COVID-19 VACCINE AD26.COV2.S-Rash. This event(s) is labeled per RSI and is therefore considered potentially related.