Post-Shingrix Vaccination Guillain-Barré Syndrome Presentation in the Emergency Department: A Case Report and Literature Review

Abstract

Guillain-Barré syndrome (GBS) is a rare neurological disorder of the peripheral nervous system. We present a case of 65-year-old female patient who developed GBS post-Shingrix inoculation. The patient, with no recognised GBS risk factors, presented with acute bilateral ascending lower limb peripheral nerve pathology eight days post-Shingrix vaccination. Other than abnormal lower limb neurological findings, her examination and biochemical results were normal. Imaging indicated possible inflammation in bilateral lumbosacral plexus. Treatment with IVIG achieved some symptom improvement, but she did not return to her baseline. Functionally, she was able to stand and mobilise 50 metres with a four-wheeled walker. Our case report highlights the importance of considering this syndrome as a differential in patients with no common GBS risk factors post-Shingrix vaccination, despite the large gap in the literature. Further studies into vaccine components as autoimmune triggers are necessary to minimise risk of GBS in the post-vaccination period.

Keywords: autoimmune; case report; guillain-barre syndrome; shingrix; vaccine; varicella-zoster.

Figure 1. T2-weighted short tau inversion recovery (STIR) hyperintense signal highlighted with red arrows in bilateral lumbosacral plexus on coronal magnetic resonance imaging.

Figure 2. Nodular thickening and hyperintensity in the left-sided sacral plexus involving the left S3 (red arrow) and S4 (green arrow) nerve roots highlighted on maximum intensity projection of coronal view magnetic resonance imaging.