Kleine Levin syndrome presenting after HINI vaccine

Abstract

Introduction A 13-fold higher risk of narcolepsy was found Irish children/adolescents vaccinated with Pandemrix compared with unvaccinated children/adolescents. Most vaccinations took place between week 42 of 2009 and week 15 of 2010. Median delay between vaccine and first symptom of narcolepsy was 2.2 months. We report a case of Klein Levine syndrome that presented in the same time frame. Objective of report is to see if other centres have experience of KlS post vaccine or post HINI. Materials and methods Case report: 15 y f patient received Pandemrix on 15/1/2010 and suddenly became very sleepy Case report: A 15 y female got HINi vaccine on 15/1/2010 and suddenly on 2/4/2010 developed severe hypersomnia with no precipitating factors, history of swine flu or other virus. Hypersomnolent phase lasted 10 days where she slept almost continuously. When awake was in trance – like state. No increase in appetite or sexual behaviour noted. A 2nd episode occured in 2010 and 3 in 2011. A trial of lithium was unsuccessful. Further less severe but more frequent episodes have occurred since. Apart from good lifestyle and the pill she is on no treatment. Results Nocturnal polysomnography, MSLT and EEG (carried out outside somnolent period) were normal. Brain MRI was normal CSF hypocretin level – 344 pg/ml Actigraphy was carried out during the last 4 days of a somnolent period and shows the contrast in daytime activity. Routine blood tests were normal. Conclusion No cases of Klein–Levine syndrome have been reported in the literature following HINI vaccine. Viral etiology is postulated at least for first episode of sleepiness. We propose that onset of KLS in this case is related to vaccine as it occurred in the middle of the Irish epidemic of narcolepsy. A second case is currently under investigation. Acknowledgement Thanks to patient for allowing us to present her case.