Abstract
Guillain-Barre syndrome (GBS) is a rare life threatening acute polyradiculoneuropathy with variable clinical presentations, including weakness, paresthesias, diminished deep tendon reflexes, hyponatremia, dysautonomia, and a cytoalbuminological dissociation on cerebral spinal fluid (CSF) analysis. The exact etiology remains unknown but is thought to occur as a post-infective immunemediated process. Vaccines and illnesses, including H1N1 Swine Flu vaccine, pneumococcal vaccine, Campylobacter jejuni bacteria, cytomegalovirus, and herpes zoster virus, have been associated with GBS. One vaccine that has not been identified to cause GBS is the newly released Shingrix® vaccine for herpes zoster infection prevention. We present a case of severe GBS following Shingrix® vaccine immunization.
Highlights
Guillain-Barré syndrome (GBS) is a rare life threatening acute polyradiculoneuropathy with variable clinical presentations [1]
GBS has been associated with many vaccines and illnesses; H1N1 Swine Flu vaccine, pneumococcal vaccine, Campylobacter jejuni bacteria, cytomegalovirus, and herpes zoster virus [2,3,4]
The Patient displayed several key features of GBS established by the Brighton Criteria of weakness; paresthesias, diminished Patellar and Achilles deep tendon reflexes, hyponatremia secondary to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH), dysautonomia, and cytoalbuminological dissociation on cerebral spinal fluid analysis
Summary
Guillain-Barré syndrome (GBS) is a rare life threatening acute polyradiculoneuropathy with variable clinical presentations [1]. The Patient had normal sensation bilaterally in upper and lower extremities. The Patient had 3/5 lower bilateral extremity strength with hip flexion. Lumbar cerebral spinal fluid studies revealed an elevated protein level (61 mg/dL), a normal white blood cell count (0 CUMM), and a cytoalbuminogenic dissociation These results indicated acute inflammatory demyelinating polyneuropathy (GBS). The patient had 5/5 bilateral upper extremity strength, 5/5 bilateral strength on lower extremity dorsiflexion, normal bilateral sensation in upper and lower extremities, and 3/5 bilateral lower extremity hip flexion strength This strength assessment was consistent with the Patient’s previous presentation. The Patient could no longer stand with and without assistance and could no longer ambulate This presentation significantly deviated from her prior discharge appearance. She was discharged to an acute rehabilitation center with scheduled physical therapy (Figures 1 and 2)
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