Sex: F
Vaccine: FLUX
Symptoms: Babinski reflex test, CSF glucose increased, CSF protein increased, Cerebral ischaemia, Chest X-ray normal
Clinical narrative: midline non-radiating, non-exertional chest pain; Headache; Loss of taste; Anxiety; lower extremity weakness; numbness; Achilles reflexes absent; difficulty ambulating; motor weakness; Facial weakness; Guillain Barre Syndrome; degenerative disc disease; acute inflammatory demyelinating polyneuropathy; atypical chest tightness; Paresthesia/paresthesia in her hands and feet; This case was reported in a literature article and described the occurrence of guillain barre syndrome in a 73-year-old female patient who received Flu unspecified (Influenza vaccine) for prophylaxis.   Concurrent medical conditions included hypertension, dyslipidemia and depression.   On an unknown date, the patient received Influenza vaccine. On an unknown date, less than 3 weeks after receiving Influenza vaccine, the patient experienced guillain barre syndrome (serious criteria hospitalization and GSK medically significant), degenerative disc disease (serious criteria hospitalization), demyelinating polyneuropathy (serious criteria hospitalization and GSK medically significant), chest tightness (serious criteria hospitalization), paresthesia (serious criteria hospitalization), chest pain (serious criteria hospitalization), headache (serious criteria hospitalization), taste loss (serious criteria hospitalization), anxiety (serious criteria hospitalization), lower extremities weakness of (serious criteria hospitalization), numbness (serious criteria hospitalization), absent ankle jerk (serious criteria hospitalization), walking difficulty (serious criteria hospitalization), weakness (serious criteria hospitalization) and facial weakness (serious criteria hospitalization). On an unknown date, the outcome of the guillain barre syndrome, degenerative disc disease, demyelinating polyneuropathy, chest tightness, paresthesia, chest pain, headache, taste loss, anxiety, lower extremities weakness of, numbness, absent ankle jerk, walking difficulty and facial weakness were unknown and the outcome of the weakness was recovering/resolving.   The reporter considered the guillain barre syndrome, degenerative disc disease, demyelinating polyneuropathy, chest tightness, paresthesia, chest pain, headache, taste loss, anxiety, lower extremities weakness of, numbness, absent ankle jerk, walking difficulty, weakness and facial weakness to be related to Influenza vaccine.  Additional details were reported as follows: This case was reported in a literature article and described the occurrence of Guillain-Barre Syndrome in a 73-year-old female patient who was vaccinated with unspecified Influenza vaccine (manufacturer unknown) for prophylaxis.  The patient had hypertension, dyslipidemia, depression. No information on patient's medical history or family history or concomitant medication was provided. On an unspecified date, the patient received unspecified Influenza vaccine (administration route and site unspecified; dosage unknown; batch number not provided). [The patient received the influenza vaccine two weeks prior to initial hospital admission]. The patient's age at the time of vaccination could be 72 or 73 years. On an unspecified date, 2 weeks after the vaccination, the patient had 2 days hospitalization for atypical chest tightness and paresthesia. The patient was hospitalized with midline non-radiating, non-exertional chest pain, new onset headache, loss of taste and paresthesia in her hands and feet. Blood pressure was 180/100. Laboratory, EKG, chest x-ray, CTA chest and CT head were unremarkable. MRI brain showed chronic microvascular ischemic changes. The patient was discharged the next day with a diagnosis of atypical chest pain secondary to anxiety. The patient returned for worsening lower extremity weakness and numbness for four days. Upon return to the hospital, the patient's mental status, cranial nerve exam and motor tone were normal. The patient had symmetric decreased temperature sensation below the elbows and knees and absent vibration sensation in the left lower extremity. Bilateral patellar and Achilles reflexes were absent and Babinski sign was down going. MRI brain was unchanged. MRI lumbar and thoracic spine were unrevealing for cord compression but showed degenerative disease. On admission, symptoms were thought to be from degenerative disc disease and possible conversion. The next day the patient described sensations in her feet like she was wearing a boot and paresthesia in her hands spread to her elbows. With concern for acute inflammatory demyelinating polyneuropathy, the patient was started on intravenous immunoglobulin for five days. On day three, the patient complained of worsening numbness progressing to her abdomen. On day four, the patient had facial weakness and deteriorating fine motor control of her hands. On day seven, lumbar puncture CSF was positive for protein of 154 and glucose of 76, revealing an albumin-cytologic dissociation. At discharge, the patient had difficulty ambulating without a walker. Four weeks later, the patient had improved motor weakness but persistently abnormal gait. This case has been considered as serious due to hospitalization. The author commented, "Guillain-Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide. We believe the influenza vaccine two weeks prior was the inciting event. With variability in presentation, atypical GBS patients are often misdiagnosed, labeled psychogenic, and sent home only to return with symptoms. The increase in GBS risk seen with vaccines against swine and H1N1 influenza also created a challenge to support the benefits of vaccines. Further exploration is justified to assess the relationship between vaccines and immune-related disorders". The author concluded, "Careful neurological exam and close follow-up are warranted to prevent unnecessary testing and reduce misdiagnosis when considering GBS. The benefit of vaccines in preventing disease need to be weighed against the risk of GBS. Factors that affect susceptibility to develop GBS warrant further investigation". This article corresponding to this case is not available for regulatory submission due to copyright restriction.