Age: 50.0
Sex: F
Vaccine: FLUX
Symptoms: Areflexia, Axonal neuropathy, CSF protein increased, Decreased vibratory sense, Electromyogram abnormal
Clinical narrative: This case was reported in a literature article and described the occurrence of Guillain Barre syndrome in a 50-year-old female subject who was vaccinated with Influenza vaccine ((unspecified), manufacturer unspecified). This case corresponds to patient 5 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). 10 days after vaccination with Influenza vaccine (unspecified), the subject experienced Guillain Barre syndrome, sensorimotor axonal neuropathy, generalized ophthalmoplegia, numbness of both upper and lower extremities and lower lip, bilateral ptosis, generalized areflexia, motor weakness in both upper and lower extremities with left side worse as compared to the right, remarkably hypoactive vestibulo-ocular reflex and sensory loss (decreased perception of sharp sensation, touch and vibration). The subject was hospitalised. Cerebrospinal fluid protein was 86 mg/dl. 4 weeks after vaccination with Influenza vaccine (unspecified), the electrodiagnostic was highly suggestive of acute inflammatory demyelinating polyneuropathy (GBS) (absent sural, median, ulnar responses), reduced motor response and absent motor units. There was an improvement 1 week later. The subject was treated with normal immunoglobulin (IVIG). At the time of discharge, there was a slow improvement in eye movements, motor and sensory response but persistent areflexia. At 4 month, bilateral facial and distal lower extremity weakness and sensory loss. The outcome of the other events was unspecified. 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.