Guillain–Barré syndrome (GBS) after severe/critical COVID-19 or COVID-19 vaccination

BACKGROUND: The global COVID-19 pandemic was initiated by the appearance of the novel coronavirus SARS-CoV-2 in 2019, presenting a spectrum of clinical manifestations from asymptomatic cases to severe pneumonia and multi-organ dysfunction, with some cases leading to death induced by hyperinflammatory responses. Neurological manifestations have been reported in more than one-third of COVID-19 patients, particularly in severe instances. While vaccines are pivotal in combating infectious diseases and enhancing public health, reports have linked Guillain-Barré syndrome (GBS) to COVID-19 vaccination and infection. This study seeks to analyze four cases of GBS associated with COVID-19. METHODS: Clinical and demographic data were collected from all patients diagnosed with GBS from a biobank, including patients with severe COVID-19 and those with autoimmune conditions resulting from COVID-19 infection or vaccination, who were referred to Alzahra University Hospital in Isfahan, Iran, between October 2020 and December. 2023. RESULTS: Clinical and demographic data of affected patients are presented. This includes a unique family case involving a daughter who passed away due to GBS following AstraZeneca vaccination, her mother who succumbed to post-COVID-19 GBS, and her father who passed away from severe COVID-19 a year earlier. CONCLUSIONS: These cases provide valuable insights into investigating potential genetic or epigenetic influences on GBS and hyperinflammation. Furthermore, the occurrence of GBS following exposure to COVID-19 and vaccination suggests shared pathways of autoimmunity induction by SARS-CoV-2 and vaccines.