Table 4 Literature review of characteristics of newly-diagnosed CIDP patients as a complication of COVID-19 vaccination
Authors | Age/ Sex | Comorbidity | Type of Vaccine/dose | Symptoms/Signs | Days from vaccine | CSF | EMG-NCV | Imaging | Treatment |
|---|---|---|---|---|---|---|---|---|---|
Oo et al. (2021) [11] | 72/M | Idiopathic neuropathy, influenza | AstraZeneca/first Influenza | • Progressive ascending lower limb sensory motor involvement • Predominantly proximal quadriparesis • Sensory changes | 21 42 | • Protein: 0.55 g/L • WBC: 0/mm3 | • Absent sensory responses • Prolonged distal motor latency with reduced nerve conduction velocity | • NA | • IVIg • Rehabilitation |
Suri et al. (2021) [10] | 47/F | DM, hypertension, and COVID-19 (7 months ago) | AstraZeneca/ first | • Progressive pure motor-flaccid quadriparesis, facial weakness • Areflexia • Recurrence with cranial nerve involvement (sixth and seventh) | 17 | • Protein: 250 mg/dL • Cells: 0/mm3 | • Demyelinating polyradiculoneuropathy • Abnormal facial and blink reflexes | • Brain MRI: hyperintensities in white matter • Lumber MRI: enhancing cauda equina thickening, avid lesion in fused PETMRI | • IVIg • Oral prednisolone • Azathioprine |
Bagella et al. (2021) [9] | 47/F | NA | Astra Zeneca/first | • Asymmetric bilateral facial weakness • Paresthesia in the tongue and face • Lower limbs areflexia • Sensory ataxia • Wide-based gait | 16 | • Protein: 110 mg/dL • WBC: 0/mm3 • No intrathecal IgG | • Slowing of conduction velocities • Prolonged distal latency and conduction blocks • Absent F response | • Brain and spinal MRI: enhancement of the facial nerves, lower thoracic nerve roots and cauda equina | • Initial IVIg followed by maintaining IVIg therapy every 6 months |
Wen et al. (2022) [12] | 23/M | None | Inactivated coronavirus vaccine/second | • Left upper limb weakness (progression to numbness and weakness of all extremities) • Areflexia | 1 | • Protein: 0.99 g/L • Cells: 4×106/L | • Reduced SNAP amplitudes in upper limbs • Reduced CMAP amplitude in all extremities • Prolonged tibial F wave latencies • EMG: neurogenic damage | • Normal brain and spinal MRI | • IVIg • High dose intravenous glucocorticoid • Plasmapheresis • Rituximab |
De Souza et al. (2022) [13] | 51/M | Congenital deafness, coronary artery disease | AstraZeneca/ first | • Low back pain • Lower limb and bifacial weakness • Severe areflexic quadriparesis • Sensory loss in the feet | 14 | • Protein: 0.70 g/L • WBC: 1 lymphocyte | • Prolonged distal latencies • Reduced NCV | • NA | • IVIg • Plasma exchange • Rehabilitation |
72/M | Localized prostate cancer, type 2 DM, hypertension, hypothyroidism | AstraZeneca/ first | • Bilateral lower limb paresthesia • Dysarthria • Gait dysfunction | 21 | • Protein: 2.02 g/L without pleocytosis | • Mixed axonal and demyelinating polyradiculoneuropathy | • Spinal MRI: enhancement of cauda equina and surface of the lower dorsal spinal cord | • IVIg • Low-dose prednisolone | |
72/M | Hypertension | AstraZeneca/ first | • Paresthesia in hands and feet • Lower limb weakness • Difficulty ambulating • Bifacial weakness • Right abducent nerve palsy • Dysarthria • Dysphagia • Areflexia | 14 | • Protein: 1.964 g/L • WBC: 9 lymphocytes | • Prolonged distal latencies • Reduced NCV • Conduction block in all of the limbs | • Spinal MRI: thickening and enhancement of lumbosacral nerve roots | • IVIg | |
72/M | Demyelinating neuropathy (stable without treatment for three years) | AstraZeneca/ first | • Paresthesia in distal lower limbs • Proximal weakness of all limbs • Areflexia and hypoalgesia in the hands, legs, and feet • Impaired proprioception • Sensory ataxia | 21 | • Protein: 0.55 g/L • Acellular | • Prolonged distal latencies • Reduced NCV • Temporal dispersion in lower limbs | • NA | • IVIg | |
Katada et al. (2022) [14] | 44/F | Dysmenorrhea, insomnia, palmoplantar pustulosis, umbilical hernia operation, food allergy | Pfizer/second | • Ascending bilateral weakness of the arms • Distal paresthesia of four limbs • Generalized areflexia | 1 | • Protein: 129 mg/dL • Cells: 1/mm3 | • Demyelinating sensorimotor polyneuropathy of median, ulnar, and sural nerve • Prolonged/absent F wave latency | • Normal spinal MRI | • Twice IVIg followed by maintaining IVIg therapy |
Devaraj et al. (2022) [15] | 30/M | NA | Covishield (ChAdOx1 nCoV-19)/first | • Quadriparesis • Facial palsy • Truncal ataxia • Generalized areflexia • Impaired posterior column sensation • Bilateral mute plantar response | 15 | • Albumin-cytological dissociation | • Sensorimotor demyelinating neuropathy with conduction block | • Brain and spinal MRI: enhancement of cauda equina, bilateral trigeminal nerves, and meatal segment of facial nerves | • IVIg for 3 months • IVMP followed by oral steroids |
Singh et al. (2022) [16] | 66/F | Type 2 DM with neuropathy, hypertension, hyperlipidemia | Moderna/ second | • Progressive lower extremity weakness • Difficulty walking • Numbness in bilateral upper extremities • Weight loss | 90 | • Protein: 237 mg/dL • Cells: 2/mm3 | • Absent sural sensory nerve response • Prolonged distal latencies • Absent/prolonged F wave • Denervation in all muscles tested in lower limbs | • Normal brain and spinal MRI | • Initial IVIg followed by maintaining IVIg therapy every 4 weeks |
Leemans et al. (2022) [17] | 79/M | NA | Pfizer/first | • Progressive upper and lower extremity weakness • Reduced vibration sense • Global areflexia | 2 | • Protein: 110 mg/dL • WBC: 6/µL | • Subacute demyelinating neuropathy • Prolonged/absent F-waves • Absent SNAPs | • NA | • IVIg • Methylprednisolone • Azathioprine |
62/M | NA | AstraZeneca/ first | • Paresthesia in the limbs, orally and in the genital area • Reduced sensation to touch and vibration • Positive Romberg sign • Weak reflexes | 28 | • Not performed | • Demyelinating neuropathy • Prolonged F-waves • Absent SNAPs | • NA | • Oral methylprednisolone with some effect on sensory complaints (stopped early due to intolerance) | |
Coelho et al. (2022) [18] | 48/M | Essential arterial hypertension | AstraZeneca/ first and second | • Anosmia, ageusia • Lower limb weakness • After second dose: • Lower limb numbness • Gait instability • Urinary dysfunction • Distal proprioception defect • Mixed lower limb ataxia • Weakened lower limb reflexes | 21: after first dose 5: after second dose | • Protein: 247 mg/dL • Cells: 0.8/mm3 | • Demyelinating sensorimotor polyneuropathy • Increased F-wave latencies | • Spinal MRI: multiple small cervical, thoracic and lumbar T2 hyperintense lesions, without contrast enhancement • Brain MRI: unremarkable | • IVMP followed by oral prednisolone |
Fofiadou et al. (2022) [19] | 62/M | NA | Ad26.COV2.S/ first | • Mild symmetric lower limb weakness • Dysarthria • Facial diplegia • Acral paresthesia • Sensory loss • Absent achilles tendon reflex | 18 | • Protein: 64 mg/dL • Cells: 0/mm3 | • Severe bilateral neuropathy with acute and chronic denervation changes | • NA | • IVIg • Plasmapheresis • Pulsed corticosteroid therapy with oral dexamethasone |
Kim et al. (2023) [20] | 72/M | NA | mRNA-1273 vaccine/NA | • Recurrent symmetric distal limb weakness • Sensory dysfunction • Areflexia | 30 | • Protein: 72 mg/dL • WBC < 5/mm3 | • Demyelinating polyneuropathy | • NA | • IVIg • Oral prednisolone • Azathioprine |
50/M | Hypertension | Ad26.COV2.S/ first | • Tingling sensation in legs • Gait disturbance • Vibration sensation deficits • Distal lower limb weakness • Areflexia • Positive Romberg test | 35 | • Protein: 158 mg/dL • WBC < 5/mm3 | • Motor demyelinating polyneuropathy • Normal NCS of sensory nerves | • No specific findings on MRI of the brain, whole spinal cord, and PET | • High-dose oral prednisolone • Azathioprine • IVIg | |
Bendi et al. (2023) [21] | 67/M | NA | Ad26.COV2.S/ NA | • Progressive lower limb weakness • Left facial palsy • Generalized areflexia • Lower extremity ataxia | 21 | • Albuminocytologic dissociation | • Impersistent F-waves • Decreased recruitment in lower extremities • Demyelination | • NA | • IVIg |
Duncan et al. (2023) [22] | 39/M | None | Pfizer/first | • Bilateral distal paresthesia • Muscle weakness • Fine motor difficulties • Ataxic gait • Areflexia in lower extremities | 14 | • Increased protein without pleocytosis | • Demyelination | • Normal brain and spinal MRI | • IVIg • Long-term prednisone therapy |
Dennis et al. (2023) [23] | 26/M | NA | Pfizer-BioNTech/first and second | • Bifacial weakness and numbness • Symmetric distally predominant weakness • Paresthesia • Facial diplegia, foot drop, areflexia | 41: after first dose 21: after second dose | • Protein: 485 mg/dL • Cells: 4/mm3 | • Chronic and active demyelinating polyradiculoneuropathy | • Spinal MRI: cauda equina nerve root enhancement | • IVIg |
45/M | NA | Johnson & Johnson/single | • Distal paresthesia and temperature sensitivity in hands and feet • Facial diplegia • Dysarthria • Dysesthesia in feet • Areflexia in left ankle | 8 | • Protein: 186 mg/dL • Cells: 6/mm3 | • Diffuse chronic and minimally active demyelinating polyradiculoneuropathy | • Brain MRI: Normal at symptom onset, trigeminal enhancement (4 months later) • Cervical and thoracic spine MRI: unremarkable | • IVIg | |
64/F | Mild COVID-19 infection (2 months prior to vaccination) | Pfizer-BioNTech/first | • Bifacial weakness • Dysarthria • Dysphagia • Acroparesthesia • Gait imbalance • Areflexia and sensory loss in lower extremities | 8 | • Protein: 217 mg/dL • Cells: 6/mm3 | • Diffuse chronic and active demyelinating polyradiculoneuropathy | • Brain MRI: mild asymmetric enhancement of the left facial nerve | • IVIg | |
Kubota et al. (2023) [24] | 39/F | Plasmacytoma | Pfizer/second | • Numbness in legs • Muscle weakness in both hands • Paresthesia and dysesthesia below the knee • Difficulty standing and walking • Areflexia | 7 | • Protein: 189 mg/dL • Cells: 1/mm3 | • Abnormal temporal dispersion and reduced motor conduction velocity in right median nerve • Decreased SNAP amplitude and velocity in median and ulnar nerves | • Brain MRI: increased signal of FLAIR in deep white matter • Lumber MRI: swollen cauda equina, enhancement of STIR in the nerve root | • IVIg • Twice IVMP • Oral prednisolone • Plasmapheresis |
Cheng et al. (2023) [25] | 74/M | Osteoarthritis of both knee joints | mRNA-1273/ second | • Weakness of hands and legs • Quadriparesis • Paresthesia over bilateral C8-T1 dermatomes • Impaired vibration and joint position in lower limbs • Generalized areflexia | 2–3 | • NA | • Typical acquired demyelination • Axonal degeneration • Absent sensory action potentials of sural nerves | • Spinal MRI: thecal sac compression at C4-C5, spondylolisthesis at L4-L5 | • Methylprednisolone (continued as intermittent pulse steroid therapy) |
Samakoush et al. (2023) [8] | 67/F | COIVID-19 infection | NA | • Weakness in all extremities • Sensory disturbances • Hyporeflexia | NA | • NA | • Conduction slowing velocity • Axonal sensory and motor polyneuropathy | • NA | • IVIg daily for 5 days; then monthly |
Freir et al. (2023) [26] | 61/M | Hypertension, type-2 diabetes, stroke, chronic lower back pain | AstraZeneca/ first | • Bilateral upper and lower limb weakness • Thoracic back pain • Areflexia | 12 | • Protein: 191 mg/dL • WBC: 0/mm3 | • Demyelinating peripheral sensorimotor neuropathy | • Brain and spinal MRI: no causative lesion | • IVIg • Plasma exchange • IVMP followed by oral steroids and azathioprine |
Karbasforooshan et al. (2024) [27] | NA | NA | Sputnik V/NA | • Progressive flaccid tetraparesis • Dysautonomia | 14 | • NA | • NA | • NA | • IVIg |
Smaoui et al. (2024) [28] | 41/M | None | AstraZeneca/ first | • Distal dominant quadriparesis • Four limb paresthesia • Areflexia • Proprioceptive ataxia | 15 | • Protein: 4.9 g/L • WBC: 1/mm3 | • Sensorimotor demyelinating polyneuropathy | • Lumbar spine MRI: no sign of myelopathy | • Plasma exchange • IVIg • Oral prednisolone |
Li et al. (2024) [29] | 42/M | Charcot-MarieTooth neuropathy type 1A | Inactivated vaccine/second | • Distal muscle weakness in all extremities • Paresthesia in distal part of all extremities • Decreased tendon reflexes • Proprioceptive ataxia | 7 | • Protein: 0.961 g/L • Cells: 1/mm3 | • Multiple peripheral nerve damage involving demyelination of motor and sensory nerves with axonal damage | • Brachial MRI: swelling of bilateral brachial plexus without marked enhancement of the nerve ganglion • Head and cervical MRI: unremarkable | • IVIg • Oral mattemycophenol ester • Oral prednisone • IVMP (After relapse) • Oral mycofenolate mofetil (After relapse) |
Saito et al. (2024)[30] | 48/F | NA | mRNA-1273/fourth (Pfizer-BioNTech for previous doses) | • Diplopia• Lower extremity weakness• Absent lower limb reflexes• Sensory disturbances | 2 | • Protein: 75 mg/dL• WBC: 2.3/μL | • Demyelinating activity in bilateral tibial nerve• Prolonged minimum latency | • NA | • Steroid pulse therapy• IVIg |
Goldberg et al. (2024) [31] | 60/M | None | NA | • Progressive bilateral lower extremity weakness • Respiratory failure • Generalized areflexia • Sensory deficits | 14 | • Albuminocytologic dissociation | • Demyelinating polyneuropathy | • Normal brain MRI | • IVIg • Steroid therapy |
Bahramy et al. (our case) | 67/M | DM, knee arthrosis | Sinopharm/ third | • Progressive paresthesia and weakness in all extremities • Generalized areflexia • Ataxia | 7 | • Protein: 210 mg/dL • WBC: 4/mm3 | • Absent CMAP amplitude in lower limbs • Prolonged distal latency, slowed conduction velocity • Demyelinating polyneuropathy | • Cervical MRI: normal • Lumbosacral MRI: bulging of the L5-S1 disc | • IVIg • Azathioprine • Prednisolone • Rehabilitation |