Age: 77.0
Sex: F
Vaccine: FLUX
Symptoms: CSF oligoclonal band present, CSF protein normal, Diarrhoea, Fall, Guillain-Barre syndrome
Clinical narrative: This case was reported in a literature article and described the occurrence of Guillain Barre Syndrome in a 77-year-old female patient who received Flu vaccine. Concurrent medical conditions included chronic kidney disease stage 3 and hypothyroidism. On an unknown date, the patient received Flu vaccine at an unknown dose. On an unknown date, 28 days after receiving Flu vaccine, the patient experienced Guillain Barre Syndrome (serious criteria hospitalization and GSK medically significant), weakness in extremity, diarrhea, fall, weakness generalized, numbness of lower extremities and areflexia. The patient was treated with Antibiotic and immunoglobulin human normal (IVIG). On an unknown date, the outcome of the Guillain Barre Syndrome, weakness in extremity, diarrhea, fall, weakness generalized, numbness of lower extremities and areflexia were unknown. The reporter considered the Guillain Barre Syndrome to be related to Flu vaccine. It was unknown if the reporter considered the weakness in extremity, diarrhea, fall, weakness generalized, numbness of lower extremities and areflexia to be related to Flu vaccine. Additional information was provided: This case was reported in a literature article and described the occurrence of Guillain-Barre Syndrome (GBS) in a 77-year-old female who was vaccinated with unspecified Influenza vaccine (manufacturer unknown). The patient's concurrent condition included chronic kidney disease stage III and hypothyroidism. No information on patient's family history was provided. No information on patient's concomitant medication was provided. On an unspecified date, the patient received an unspecified influenza vaccine (administration route and site unspecified; dosages unknown; batch number not provided). On an unspecified date, 4 weeks after vaccination with unspecified Influenza vaccine, the patient presented with falls from generalized weakness in the setting of a diarrheal illness. It was reported that, for the past 9 days, the patient endorsed non-bloody watery diarrhoea twice a day, without vomiting, pain, or fever. One day prior to presentation, the patient developed lower extremities weakness and numbness. On the day of presentation, the patient had upper extremities weakness and difficulty with silverware. The patient was hospitalised. Shortly after admission, antibiotics (unspecified) were held as diarrhoea resolved. Her examination revealed normal vital signs, non-tender abdomen, decreased extremity sensation, decreased strength (plantar flexion R 3/5, L 2/5; dorsiflexion R 1/5, L0/5; straight leg raise both 2-3/5; hand grip both 2-3/5; triceps both 2/5; and biceps both 3/5), and areflexia. The patient's laboratory results showed leukocytes at 64,000/uL, haemoglobin at 10.3 g/dL; platelet count of 475,000/uL, creatinine at 1.23mg/dL, and thyroid stimulated hormone, B12 and Lyme reflex were normal. Her stool cultures grew Salmonella group D. Spine magnetic resonance imaging showed degenerative changes without compression. Lumbar puncture was performed given suspicion for GBS. Cerebral spinal fluid (CSF) analysis revealed normal results with protein at 36 mg/dL and nucleated cells 1/uL. The patient received five days of empiric IVIG treatment which led to an improvement in neurologic examination (3/5 in LE, 4/5 in UE). CSF eventually returned positive for oligoclonal bands, consistent with GBS. Nerve conduction studies were scheduled as an outpatient. This case was considered serious due to hospitalisation. The outcome of the event was not reported. The author commented that "Seasonal Influenza vaccination, within the past 6 weeks, is also associated with GBS". The trigger for her GBS was likely her antecedent Salmonella infection. The authors stated that "GBS is an acute self-limiting immune-mediated polyradiculopathy presenting with ascending paralysis and areflexia. Two-thirds of GBS follow a gastrointestinal (GI) or respiratory infection. Of the associated GI pathogens, Campylobacter jejuni is most common (30% of all GBS cases) but Salmonella typhi has been reported. Although the risk of GBS with Influenza vaccine is statistically significant, the absolute risk is only 2 in a million. The annual morbidity and mortality associated with influenza infections far outweighs the risk of vaccine induced GBS."