P-PN006. Guillain barré syndrome treatment related fluctuation (GBS-TRF) following meningococcus vaccination: A case report

Abstract

Introduction . GBS is an autoimmune neurological disorder, characterized by acute limb weakness and areflexia. The pathogenesis of GBS is triggered mostly by infection process. However, the consequence of vaccination can cause GBS has been widely discussed. Some studies address the potential relationship of GBS to influenza vaccination, while other vaccination is rarely described. In this study, we reported a case of GBS-TRF after administration of meningococcus vaccination. Case presentation: A 64-year-old man presented with glove-stocking hypoesthesia followed by flaccid tetraparesis, which occurred two weeks after meningococcus vaccination. There were no history of any infectious diseases preceding his symptoms. He and his family were administered these vaccinations, as the prerequisite for going to Umrah. After coming back of his Umrah, he was diagnosed with GBS based on history, clinical features and test results. Neurological examination revealed absent of knee and ankle reflexes. Nerve conduction studies indicated the decreased of sensory nerve action potential, amplitudes and conduction velocity, also prolongation of distal latency. He had six times therapeutic plasma exchange (TPE) and the symptoms slightly resolved at discharge. One month after plasma exchange, he was readmitted due to dyspnea, worsening of his weakness and severe hyponatremia. He was transferred to intensive care unit with mechanical ventilation. He was diagnosed as GBS-TRF. The treatment was intravenous immunoglobulin (IVIG) with full dose of 400 mg/kg/day. Unfortunately, the patient developed some complications during intensive care. He did not survive, suffering from cardiac arrythmia and septic shock, after IVIG treatment. Conclusion . Meningococcus vaccination may cause GBS as an unexpected abnormal autoimmune response. It is important to note the possibility of neurological complications after vaccine administration.