Age: 79.0
Sex: M
Vaccine: FLUX, FLUX
Symptoms: CSF white blood cell count negative, Chest X-ray abnormal, Computerised tomogram head normal, Dialysis hypotension, Dyspnoea
Clinical narrative: Acute hypercapnic respiratory failure; Hypoxemia with oxygen saturation of 88% on room  air; Pulmonary vascular congestion; Albuminocytologic dissociation; Diagnosis of GBS; NIH stroke scale score of 4; Right-sided pleural effusion; Extent of hypercapnia; Dyspnoea; Generalized weakness; Hypotensive at 79/50 mmHg; Rightleaning posture; Repetitive speech; Hypotensive episodes; Altered mentation; This Literature - Spontaneous case, initially received on 18-Jun-2024, was reported by a health professional and concerns an elderly male patient.  This case report described a 79-year-old patient with cute hypercapnic respiratory failure after who was recently vaccinated with influenza vaccine which led to a diagnosis of Guillain-Barre syndrome (GBS).  Past medical history included Hypotensive episodes during dialysis sessions over the past week. The patient's medical procedures included Dialysis, Chest X-ray, Blood pressure measurement, arterial blood gases (ABG), magnetic resonance imaging (MRI), CT brain scan, Lumbar puncture, Intubation, physical exam, Oxygen saturation measurement, Extubated. At the time of the event the patient had End stage renal disease (ESRD), Diabetes mellitus, Hypertension, Atrial fibrillation.  Administration of company suspect drug(s): On an unknown date, the patient received Influenza vaccine (brand not specified) for unreported Indication, Lot number: Not reported.  No additional suspect drugs.  Adverse reactions/events and outcomes: On an unknown date, two weeks after receiving Influenza vaccine, the patient was presented to the emergency department (ED) with generalized weakness and dyspnoea. The physical exam showed no neurological deficits but showed hypoxemia with an oxygen saturation of 88% on room air. Chest x-ray demonstrated a right-sided pleural effusion with pulmonary vascular congestion.  On an unknown date, reported as the following day, the patient became hypotensive at 79/50 mmHg and demonstrated right leaning posture, repetitive speech, and altered mentation, prompting a call for a code stroke. He had an NIH Stroke Scale Score of 4 and was transferred promptly to the ICU for airway protection. Initial ABG showed severe acute hypercapnic respiratory failure with pH 6.99 and pCO2 > 125 mmHg. Within a few hours, post-intubation ABG revealed significant improvement in pH 7.45 and pCO2 35 mmHg. Additionally, MRI and CT brain scans showed no acute intracranial abnormality. The rapid deterioration and the extent of hypercapnia raised concerns for neurological differentials, especially with the patient requiring minimal ventilatory support. A follow-up lumbar puncture revealed albuminocytologic dissociation. The patient was subsequently treated with a 5-day IVIG course and extubated successfully.  At the time of initial reporting, the patient recovered from all events. As reported, prompt diagnosis via lumbar puncture and timely treatment with IVIG led to successful patient outcomes, emphasizing the need for diagnostic vigilance.  In conclusion, this case highlighted the importance of considering GBS as a differential for rapid onset of respiratory failure in recently vaccinated individuals, particularly in elderly patients with no recent infections. While GBS was often associated with infections, there was a temporal link post-vaccination with GBS pathogenesis.  Reporter's assessment: The reporter did not provide a causality assessment.; Reporter's Comments: Causal role of the suspect vaccine for the events of cerebrovascular accident, hypotension, rightleaning posture, repetitive speech, and altered mentation is assessed as not related based on biological implausibility. There is no physiological connection by which vaccination and the immune response could cause aforementioned events. Causality for the rest of the events is assessed as possibly related. Compatible temporal relationship implies that suspect vaccine contributed to the potential occurrence of the reported events. Brighton Collaboration criteria for Guillain-Barre syndrome is assessed as Level 2.