A four-year-old girl with Guillain-Barre syndrome that developed 10 days following H influenzae type b conjugate vaccine immunization is reported from Geneva, Switzerland. CSF contained 1 mononuclear cell/cmm and 0.89 g/1 protein. Nerve conduction velocities were decreased in upper and lower extremities. Measurements of immunoglobulins against the polysaccharide (PRP) component of the vaccine showed a marked elevation (100 mcg/ml) of the anti-PRP IgM antibody level. Following treatment with two 5-day courses of intravenous immunoglobulins (0.4 g/kg/day) 2 weeks apart, cranial nerve function and muscle strength improved. Apart from absent deep tendon reflexes, the neurological exam was normal at one month follow-up. [1]
COMMENT. A total of five cases of Guillain-Barre syndrome (GBS) following vaccination with the H influenzae type b diphtheria toxoid-conjugate vaccine have been reported. The authors speculate that an excessive anti-PRP IgM antibody response to the vaccine might explain this rare complication.
Treatment of acute GBS is controversial and not without risk, especially in patients with vascular disease. Two adults died from vascular thrombotic complications following gamma globulin therapy for GBS. [2]