Guillain-Barré syndrome in an older man following influenza vaccination

OBJECTIVE To report an atypical case of Guillain-Barré syndrome (GBS) after administration of the 2012-13 influenza vaccine. SETTING Urban tertiary hospital. PATIENT DESCRIPTION An 81-year-old man was admitted to the hospital after he began experiencing numbness and tingling in both feet that began ascending toward the waistline. The patient complained of intense neuropathic pain in his lower extremities and eventually lost the deep tendon reflexes in his ankles. CASE SUMMARY In addition to clinical manifestations of GBS, electromyography revealed a sensorimotor, polyneuropathy, predominantly axonal, with prolonged F-waves in all nerves tested. A lumbar puncture revealed clear and colorless cerebrospinal fluid with an elevated protein level of 66 mg/dL (reference, 15-60 mg/dL) despite the lack of a normal cell count, which indicates albuminocytologic dissociation. Based on these findings, the patient met Brighton level 3 diagnostic certainty and was diagnosed with GBS. MAIN OUTCOMES MEASURE Signs and symptoms of GBS. RESULTS On day 5 of hospitalization, intravenous immunoglobulin 0.4 mg/kg/d was initiated for 5 days in combination with gabapentin 100 mg at bedtime for neuropathic pain. After completing treatment, the patient experienced progressively improved sensation in his extremities and was discharged. CONCLUSION This is a rare report of GBS lacking albuminocytologic dissociation after an older patient received the 2012-13 influenza vaccine.