Sex: M
Vaccine: VARZOS
Symptoms: Pulse absent, Sensory loss, Sinus rhythm, Syncope, Unresponsive to stimuli
Clinical narrative: ventricular tachycardia; acute transverse myelitis; ascending bilateral lower extremity paresthesia/ The paresthesia progressed fromhis feet to groin; loss of sensation; urination; incomplete bladder emptying/ Urinary retention; ambulatory dysfunction due to difficulty with proprioception of both his legs; acute onset of diaphoresis; lightheadedness; syncopal episode; unresponsive; condition aggravated; This serious case was reported in a literature article and described the occurrence of ventricular tachycardia in a 50-year-old male patient who received Herpes zoster (Shingles vaccine) for prophylaxis.    Concurrent medical conditions included psoriatic arthritis. Concomitant products included methotrexate.   On an unknown date, the patient received Shingles vaccine (unknown arm). On an unknown date, 1 week after receiving Shingles vaccine, the patient experienced ventricular tachycardia (Verbatim: ventricular tachycardia) (serious criteria GSK medically significant), myelitis transverse (Verbatim: acute transverse myelitis) (serious criteria GSK medically significant), paresthesia lower limb (Verbatim: ascending bilateral lower extremity paresthesia/ The paresthesia progressed fromhis feet to groin), loss of sensation (Verbatim: loss of sensation), urination impaired (Verbatim: urination), incomplete bladder emptying (Verbatim: incomplete bladder emptying/ Urinary retention) (serious criteria GSK medically significant), diplegia of lower limbs (Verbatim: ambulatory dysfunction due to difficulty with proprioception of both his legs) (serious criteria GSK medically significant), diaphoresis (Verbatim: acute onset of diaphoresis), light headedness (Verbatim: lightheadedness), syncopal attack (Verbatim: syncopal episode) (serious criteria GSK medically significant), unresponsive to stimuli (Verbatim: unresponsive) (serious criteria GSK medically significant) and condition aggravated (Verbatim: condition aggravated). The patient was treated with amiodarone and methylprednisolone sodium succinate (Solumedrol). The outcome of the ventricular tachycardia, myelitis transverse, paresthesia lower limb, loss of sensation, urination impaired, incomplete bladder emptying, diplegia of lower limbs, diaphoresis, light headedness, syncopal attack, unresponsive to stimuli and condition aggravated were resolving.   The reporter considered the ventricular tachycardia, myelitis transverse, paresthesia lower limb, loss of sensation, urination impaired, incomplete bladder emptying, diplegia of lower limbs, diaphoresis, light headedness, syncopal attack, unresponsive to stimuli and condition aggravated to be possibly related to Shingles vaccine.     The company considered the ventricular tachycardia, myelitis transverse, paresthesia lower limb, loss of sensation, urination impaired, incomplete bladder emptying, diplegia of lower limbs, diaphoresis, light headedness, syncopal attack, unresponsive to stimuli and condition aggravated to be possibly related to Shingles vaccine.   Additional Information: GSK Receipt Date: 02-May-2023 The author presented a case of 50-year-old male with a history of psoriatic arthritis on methotrexate presented to the emergency room (ER) one week following a shingles vaccine with complaint of ascending bilateral lower extremity paresthesia. The paresthesia progressed from his feet to groin with associated loss of sensation with urination, incomplete bladder emptying, and ambulatory dysfunction due to difficulty with proprioception of both his legs. Examination was significant for diminished light touch, vibration, and temperature sensation of the bilateral lower extremities. Urinary retention was noted and was treated with a foley catheter. MRI imaging of the patient's spine revealed longitudinally extensive T2 hyperintensity from the lower cervical spine to the upper thoracic spine. The patient's ER course was complicated by acute onset of diaphoresis and lightheadedness followed by a syncopal episode. The patient was unresponsive and pulseless, and the telemetry was consistent ventricular tachycardia which was quickly self-limiting with return of mental awareness and normal sinus rhythm. Amiodarone was initiated and the patient remained in normal sinus rhythm. He was treated with 1 g of IV solumedrol for suspected ATM based on clinical presentation and spinal cord appearance on MRI. However, there was no clinical improvement after 5 days of IV steroid treatment and the decision was made to initiate plasmapheresis. Plasmapheresis was well tolerated and the patient's symptoms gradually improved. Extensive blood work and CSF studies failed to determine the etiology of the ATM. The patient's symptoms continued to progress, and he was discharged to a rehab facility with long-term cardiac event monitoring. The author also reported that as the patient in case had a recent Shingles vaccine, which was also live attenuated vaccine of the VZV virus, there was a possible argument that can be made of the link between the patient's ATM and the Shingles vaccine. As varicella was a potential cause of tachycardia via myocarditis, and vaccinations have an association with myocarditis, it was possible that patient's ventricular tachycardia could also be related to the Shingles vaccine