Guillain-Barre

“Case Reports

Case 1. A male aged 18 years was vaccinated with MCV4; 15 days later, he experienced tingling in his feet and hands. He had no history of major underlying illness; his mother had had GBS 5 years earlier. He reported no history of respiratory or gastrointestinal illnesses during the 6 weeks before onset of symptoms. Sixteen days after vaccination, he was hospitalized, and nerve conduction studies (NCS) of upper and lower extremities, 2 days after onset of symptoms, were consistent with GBS. He was observed for 3 days, discharged, and then readmitted 2 days later with bilateral facial weakness and increasing lower extremity weakness. Patellar, triceps, and biceps deep tendon reflexes (DTRs) were absent. NCS performed 4 days after the previous examination revealed worsening motor nerve conduction velocities consistent with GBS. Tests for mononucleosis and Lyme disease were negative. During hospitalization, he was treated with plasmapheresis. His facial palsy and gait improved, and his reflexes returned. He was discharged home.

Case 2. A male aged 17 years was vaccinated with MCV4; approximately 25 days later, he had difficulty walking, followed by difficulty moving from a standing to a seated position. Medical history included attention deficit hyperactivity disorder and Asperger syndrome; he had been taking multiple psychotropic medications. He did not report recent respiratory or gastrointestinal illness. Thirty-two days after vaccination, he was hospitalized with bilateral muscle weakness of upper and lower extremities with absent DTRs. NCS was consistent with GBS. Cerebrospinal fluid (CSF) analysis revealed 2 white blood cells (WBC)/mm3 with protein of 60 mg/dL; bacterial cultures were negative. DNA polymerase chain reaction (PCR) for adenovirus, herpes simplex virus types 1 and 2, varicella zoster virus, cytomegalovirus (CMV), and Epstein-Barr virus (EBV), and RNA PCR for West Nile virus, eastern equine encephalitis virus, St. Louis encephalitis virus, enterovirus, and California group and Cache Valley viruses, were all negative. During hospitalization, he was treated with intravenous immunoglobulin (IVIG). On discharge, his motor strength and gait were improved.

Case 3. A female aged 17 years was vaccinated with MCV4. She had a previous history of GBS at ages 2 and 5 years, both beginning 14 days after vaccination with childhood vaccines. She had not been previously vaccinated with meningococcal vaccine. Both episodes of GBS were characterized by muscle weakness, decreased reflexes, and difficulty walking. During both episodes, she was treated with intravenous immunoglobulin and completely recovered. Fourteen days after vaccination with MCV4, she reported numbness of toes and tongue and had a lump in her throat. These symptoms were followed by numbness of thighs and fingertips, arm weakness, inability to run, difficulty walking, and falling. Sixteen days after vaccination, she was hospitalized, and neurologic examination revealed decreased tone and weakness of both arms and legs and reflexes reduced or absent in ankles, knees, and arms. CSF results revealed 0 WBC/mm3 and protein 26 mg/dL. She was treated with IVIG, recovered, and discharged home.

Case 4. A female aged 18 years was vaccinated with MCV4. Six days after vaccination, she had a sore throat that lasted for 6 days, and 29 days after vaccination she reported a severe headache and was evaluated in an emergency department (ED), where she had a normal computerized tomography (CT) scan, was treated with ketorolac, and discharged on oral ibuprofen. Thirty-one days after vaccination, the patient reported numbness of legs and had trouble standing on her toes. The next morning she could not stand. The patient was admitted to the hospital, and physical examination revealed decreased muscle strength in ankles and wrists bilaterally and reduced biceps, knee, and ankle DTRs. Previous medical history included mild ulcerative colitis that had been asymptomatic off medications; she did not report having diarrhea during the 6 weeks before onset of muscle weakness. Her only outpatient medications were oral contraceptives. CSF analysis revealed 1 WBC/mm3 and a protein concentration of 30 mg/dL. NCS was consistent with GBS. She was treated with IVIG. After a 7-day hospitalization, her motor strength had improved, and she was discharged home with outpatient physical therapy. Three weeks after discharge, her weakness and gait were improved.

Case 5. A female aged 18 years was vaccinated with MCV4; 14 days later, she experienced heaviness in her legs when walking upstairs. During the next 8 days, her difficulty walking continued, and she had bilateral leg pain. Subsequently, she reported headache, back and neck pain, vomiting, and tingling in both hands. She became unable to walk and was evaluated in an ED, where an initial diagnosis of viral meningitis was made. Two days later, she was hospitalized for progressive weakness and inability to walk. Neurologic examination revealed bilateral acute flaccid weakness with decreased DTRs.”

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https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5440a6.htm

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Guillain - Barre’ syndrome following recombinant hepatitis B vaccine and literature review.