13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE-INDUCED GUILLIAN-BARRÉ SYNDROME

Abstract

SESSION TITLE: Medical Student/Resident Allergy and Airway Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Guillian Barré syndrome (GBS) is an acute immune mediated polyneuropathy which presents as monophasic paralyzing illness typically provoked by a preceding infection. The overall incidence of GBS is 1-2 cases a year per 100,000.1,2 An increased risk of GBS has been associated with the influenza vaccination.3 Despite the association of GBS with the influenza vaccine, there are limited cases of GBS documented with the pneumococcal vaccination. We present a case of GBS following the 13-valent pneumococcal conjugate vaccine (PCV13). CASE PRESENTATION: 61-year-old male with a past medical history of a stroke, coronary artery disease, and hypertension presented with lower extremity weakness and decreased sensation. He reported tingling in his feet which had been progressing up to his knees, with associated weakness. He had received PCV13 2 weeks prior to admission. He denied upper respiratory infections, or diarrhea. Lab were significant for leukocytosis 13.0 cells/microL. Muscle strength was 1/5 in the left lower extremity and 3/5 in the right lower extremity. Sensory motor deficits were noted up to the level of the mid shin bilaterally. Lumbar puncture demonstrated 0 RBCs, glucose 65 mg/dL, and protein elevated 79 mg/dL. CSF culture was negative. Nerve conduction study revealed evidence of severe sensorimotor demyelinating peripheral neuropathy. Work-up including a viral respiratory panel and influenza nasal swab were negative. The patient was started on intravenous immune globulin (IVIG) infusion at 1 g/kg once daily for a total of 5 days. DISCUSSION: Guillain-Barré Syndrome (GBS) is a rare acute flaccid paralysis syndrome commonly preceded by symptoms of upper respiratory tract infection or diarrhea within the prior 3 months. The underlying etiology of GBS remains unclear, but the pathophysiology in most cases of GBS is due to stimulation of autoimmunity that produces auto-immune antibodies that attack the myelin sheath of the nerves in the peripheral nervous system. In the case of our patient, he appropriately received PPSV23 prior to 65 years of age because of his chronic lung disease but he did not have a compelling indication to receive PCV13. There is inconclusive data that the greater immunogenicity of PCV13 leads to a higher incidence of immune reactions potentially leading to GBS. CONCLUSIONS: Pneumococcal vaccination is generally safe and effective with a very low chance for serious adverse events. Carefully administering PCV13 when truly indicated can further minimize the potential for harm. The development of injection site reactions should be carefully monitored as higher IgG-specific antibody titers could increase risk of GBS. Despite some of the recent reports of GBS associated with the pneumococcal vaccine, the overall benefit of preventing life-threatening infections largely outweighs the potential risks for adverse drug events. Reference #1: Yuki N, Hartung HP. Guillain-Barré syndrome. N Engl J Med. 2012 Jun 14;366(24):2294-304. doi: 10.1056/NEJMra1114525. Reference #2: Sejvar JJ, Baughman AL, Wise M, Morgan OW. Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis. Neuroepidemiology 2011; 36:123 DISCLOSURES: No relevant relationships by Chad Conner, source=Web Response No relevant relationships by Alexander Levine, source=Web Response No relevant relationships by Zhongyang Liu, source=Web Response no disclosure on file for John Osowski; No relevant relationships by Nishka Shetty, source=Web Response