背景:严重的疫苗接种后神经系统并发症很少见。慢性炎症性脱髓鞘性多发性神经病(CIDP)是一种免疫介导的多发性神经病,影响周围神经根,这不是很好地描述为疫苗接种后的副作用。这里,我们提出了一种罕见的SARS-CoV-2疫苗接种并发症,诊断为CIDP。
方法:一名67岁的糖尿病男性在接受第三剂Sinopharm(BBIBP-CorV)疫苗后出现下肢感觉异常和无力。尽管最初被解雇为糖尿病并发症,症状升级,影响所有四肢。肌电图研究显示异常自发活动伴有慢性神经支配改变,这在下肢更为显著。根据临床过程,射线成像,和实验室数据,建立了具有严重轴突脱髓鞘特征的CIDP的诊断。静脉注射免疫球蛋白(IVIg)治疗,泼尼松龙,硫唑嘌呤和硫唑嘌呤可明显改善上肢,但下肢远端肌肉的恢复有限。
结论:尽管CIDP是COVID-19疫苗接种后的一种罕见并发症,在鉴别诊断中应考虑。及时诊断疫苗诱导的CIDP具有挑战性,任何延误都会对受影响患者的治疗反应产生不利影响。
BACKGROUND: Severe post-vaccination neurological complications are rare. Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is an immune-mediated polyneuropathy affecting the peripheral nerve roots, which is not well described as a post-vaccination side effect. Here, we present a rare complication of vaccination against SARS-CoV-2, reaching a diagnosis of CIDP.
METHODS: A 67-year-old diabetic male presented with lower extremity paresthesia and weakness following the third dose of the Sinopharm (BBIBP-CorV) vaccine. Despite initial dismissal as a diabetic complication, symptoms escalated, affecting all extremities. Electromyography study revealed abnormal spontaneous activity with chronic reinnervation changes, which was more significant in the lower extremities. Based on the clinical course, radiographic imaging, and laboratory data, a diagnosis of CIDP with severe axonal demyelinating features was established. Treatment with intravenous immunoglobulin (IVIg), prednisolone, and azathioprine resulted in marked improvement of the upper extremities but limited recovery in distal lower extremity muscles.
CONCLUSIONS: Although CIDP is a rare complication following COVID-19 vaccination, it should be considered in the differential diagnosis. Timely diagnosis of vaccine-induced CIDP is challenging, and any delay can adversely affect treatment response in affected patients.