Sex: F
Vaccine: VARZOS
Symptoms: Angiogram cerebral abnormal, CSF oligoclonal band present, CSF protein increased, CSF test abnormal, Gaze palsy
Clinical narrative: lower extremity weakness; reversible cerebral vasoconstrictive syndrome; Suspected vaccination failure; VZV meningoencephalitis; recurrent VZV; severe headache; seizure; altered mental status; gaze deviation; urinary incontinence; This serious case was reported in a literature article and described the occurrence of vaccination failure in a 42-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis.   Concurrent medical conditions included connective tissue disorder, interstitial lung disease and lung transplant. Concomitant products included mycophenolate mofetil (Mycophenolate), hydroxychloroquine and prednisone.   In JAN-2023, the patient received Shingrix. In APR-2023, couple of months after receiving Shingrix, the patient experienced headache (Verbatim: severe headache), seizure (Verbatim: seizure) (serious criteria GSK medically significant), mental status changes (Verbatim: altered mental status), head and eye gaze deviation (Verbatim: gaze deviation) (serious criteria GSK medically significant) and urinary incontinence (Verbatim: urinary incontinence). In MAY-2023, the patient experienced lower extremities weakness of (Verbatim: lower extremity weakness) (serious criteria hospitalization). On an unknown date, the patient experienced vaccination failure (Verbatim: Suspected vaccination failure) (serious criteria GSK medically significant), meningoencephalitis (Verbatim: VZV meningoencephalitis) (serious criteria GSK medically significant), varicella zoster (Verbatim: recurrent VZV) and cerebral vasoconstriction (Verbatim: reversible cerebral vasoconstrictive syndrome) (serious criteria GSK medically significant). The patient was treated with aciclovir (Acyclovir) and valaciclovir (Valacyclovir). The outcome of the vaccination failure was unknown and the outcome of the meningoencephalitis, varicella zoster, headache, seizure, mental status changes, head and eye gaze deviation, urinary incontinence, cerebral vasoconstriction and lower extremities weakness of were not reported.   The reporter considered the vaccination failure, meningoencephalitis, varicella zoster, headache, seizure, mental status changes, head and eye gaze deviation, urinary incontinence, cerebral vasoconstriction and lower extremities weakness of to be related to Shingrix.     The company considered the vaccination failure, meningoencephalitis, varicella zoster, headache, seizure, mental status changes, head and eye gaze deviation, urinary incontinence, cerebral vasoconstriction and lower extremities weakness of to be related to Shingrix.   Additional Information: GSK received date: 13-May-2024  A 42-year-old woman with connective tissue disease (CTD) overlap syndrome-related interstitial lung disease treated with mycophenolate, hydroxychloroquine, and prednisone was undergoing lung transplant (LT) evaluation in January 2023. She presented in April 2023 for new onset severe headache, seizure, altered mental status, gaze deviation, and urinary incontinence. Cerebrospinal fluid (CSF) analysis showed elevated protein, lymphocytic pleocytosis, high HSV1 IgG, high VZV IgG, and low VZV IgM. Viral PCR in blood was negative. MRA of the head demonstrated beaded appearance of M1 and M2 branches, suggesting reversible cerebral vasoconstrictive syndrome (RCVS). Cerebral angiogram was negative for vasculitis prompting treatment with intravenous acyclovir for 14 days. Follow-up MRI in May 2023 demonstrated leptomeningeal enhancement; the patient was readmitted for lower extremity weakness. Inpatient imaging demonstrated multifocal abnormal areas of nodular leptomeningeal enhancement involving cauda equina roots, and new linear tract of left frontal white matter abnormality. Repeat CSF analysis demonstrated elevated protein, lymphocytic pleocytosis, high HSV 1/2 IgG, high VZV IgG, high VZV IgM, and oligoclonal bands. The patient was treated with intravenous valacyclovir for 3 weeks for recurrent VZV meningoencephalitis. She was now following with neurology for motor deficits due to the possibility of MS and RCVS. Of note, she had received the Shingrix vaccine in January 2023 as pre-LT requirement.