Age: 61.0
Sex: M
Vaccine: FLUX
Symptoms: Muscular weakness, Musculoskeletal pain, Neurological examination abnormal, Paraesthesia, Positive Rombergism
Clinical narrative: This case was reported in a literature article and described the occurrence of Guillain Barre Syndrome in a 61-year-old male subject who was vaccinated with influenza virus vaccine (Influenza vaccine (unspecified), manufacturer unspecified). This case corresponds to patient 1 in the literature article. On an unspecified date, the subject received an unspecified dose of Influenza vaccine (unspecified) (administration site and route unknown, batch number not provided). 1 week after vaccination with Influenza vaccine (unspecified), the subject experienced hand and feet numbness, parascapular pain, weakness and gait disturbance. The subject was hospitalised. The neurological examination showed proximal weakness (4+/5) in all extremities, absent vibration and joint position at bilateral toes and ankles, reduced pin-prick and light touch at bilateral feet and hands, severe sensory ataxia, generalized loss of deep tendon reflex and positive Romberg sign. The cerebrospinal fluid protein was 58 mg/dl. 15 days after vaccination with Influenza vaccine (unspecified), the final diagnosis was highly suggestive of acute inflammatory demyelinating polyneuropathy (sural sparing, prolonged distal latencies and absent F responses). The subject was treated with normal immunoglobulin (IVIG). At the time of discharge, gait disturbance, ataxia, vibration and joint position were improved. Numbness in hand feet continued for a longer period. The outcome of the other events was unspecified. The 4 other cases described in the article are recorded under B0799679A, B0799780A, B0788782A, and B0799785A. Summary of the literature article: Recent epidemiological studies established extremely rare incidence of Guillain-Barre syndrome after contemporary H1N1-influenza vaccine. The authors reported five subjects with 'atypical? GBS variants that started within four weeks of 2010/2011 H1N1-influenza vaccine. There was no evidence for other etiologies of GBS. The subjects presented with sensory ataxia, areflexia, extremity and oropharyngeal paresthesias, numbness, pain, weakness, sphincteric disturbances, and dysautonomia. One subject had Miller Fisher Syndrome. All had elevated cerebrospinal fluid protein, and classic electrodiagnostic finding suggestive of GBS. All received the treatment with intravenous immunoglobulin with variable response. The authors's conclusion stated that his series of subjects did not necessarily establish cause-effect relationship between the vaccination and the disease. They also emphasized that they coudn't draw general conclusion concerning the types of GBS after H1N1-influenza vaccine in larger populations. Epidemiological studies with large cohort were necessary to confirm excess cases of atypical GBS after H1N1-influenza vaccination. They also speculated the possibility that more "typical GBS after H1N1-influenza vaccine did not reach their attention at tertiary-care center but were treated by community neurologists. Nevertheless, the main message that we can draw from this study is that high index of suspicion and screening for atypical variant of GBS was warranted for the H1N1-influenza vaccinees who present with neuropathic manifestations within four weeks of vaccination.