Age: 76.0
Sex: F
Vaccine: FLUX
Symptoms: Areflexia, Asthenia, Axonal neuropathy, Balance disorder, CSF protein increased
Clinical narrative: This case was reported in a literature article and described the occurrence of Guillain Barre syndrome in a 76-year-old female subject who was vaccinated with Influenza vaccine ((unspecified), manufacturer unspecified). This case corresponds to patient 3 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). 4 weeks after vaccination with Influenza vaccine (unspecified), the subject experienced sensorimotor axonal neuropathy, paresthesia, numbness in bilateral toes progressing to both legs and then to bilateral fingers, loss of balance, poor dexterity and dysphagia. On neurological examination, the subject had a generalized weakness (graded 4/5). Decreased pinprick, joint position and vibration in both lower extremities. She had unsteady gait and stance. Deep tendon reflexes 1+ in both upper extremities and absent patellar and ankle reflexes. The subject was hospitalised. Cerebrospinal fluid protein was 78 mg/dl. 7 weeks after vaccination with influenza vaccine (unspecified), the electrodiagnostic was highly suggestive of acute inflammatory demyelinating polyneuropathy (sural sparing, prolonged distal latencies and absent or abnormal F responses). The subject was treated with normal immunoglobulin (IVIG). At the time of discharge, the events were improved. Improved sensations, slow improvement of weakness and dysphagia in one week after the course of IVIG. 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 author's conclusion stated that this series of subjects did not necessarily establish cause-effect relationship between the vaccination and the disease. They also emphasized that they couldn'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" cases of 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.