Case presentation: Girl, 9 years old, started weakness in lower limbs, frequent falls with progressive
worsening of ascending weakness and later distal involvement of upper limbs, in addition
to burning pain in the calves. About eight days before the condition, she received
vaccination with the 2nd dose of coronavac. At the initial evaluation, the patient
had normal cognitive examination, incomplete tetraparesis with symmetrical crural
predominance, on the MRC scale in lower limbs grade II and in upper limbs grade IV,
absent osteotendinous reflexes, preserved superficial and deep sensitivity, cranial
nerves without alterations. Normal sphincter function. Analysis of cerebrospinal fluid
on the 3rd day of symptoms without alterations, however, in an electroneuromyographic
study, non-length dependent multifocal motor axonal polyneuropathy was evidenced compatible
with Guillain-Barré syndrome (AMAN variant). The patient was treated with intravenous
human immunoglobulin for five days, in view of the evidence of clinical worsening
over the five days due to the appearance of new superficial hypoesthesia and electroneuromyographic
worsening that showed multifocal and non-length-dependent sensory and motor axonal
polyneuropathy (AMSAN)., performed five sessions of plasmapheresis, with partial improvement.
Discussion: Guillain-Barré syndrome is characterized by post-trigger autoimmune peripheral nerve
involvement, in most cases infectious, either of the myelin sheath or of the axon
itself, which classically courses with acute/subacute ascending a reflex weakness,
with symptoms peaking at around 2 to 3 weeks. Typically, a cytological protein dissociation
is observed in the CSF, but many patients may not experience dissociation in the first
three weeks. Another useful test, especially for classifying the pattern of involvement,
is electroneuromyography. Acute treatment involves intravenous human immunoglobulin
and/or plasmapheresis, in addition to symptomatic treatment and clinical support.
Chronic treatment involves a multidisciplinary team to ensure rehabilitation.
Final comments: We considered the case of interest for exposure, in view of the temporal report of
vaccination with the coronavac vaccine, without other possible triggers associated
with the outbreak of the condition. It is important to know the syndrome for the correct
diagnosis and follow-up of these patients.
