Recurrence of a Rare Subtype of Guillain-Barré Syndrome Following a Second Dose of the Shingles Vaccine

Abstract

Guillain-Barré Syndrome (GBS) is an acute, immune-mediated polyneuropathy. The exact cause of GBS remains unknown, however, it commonly develops post-infection. Since the 1950s, various vaccines have been attributed to causing the syndrome, yet no definitive relationship has ever been determined. In 2021, the Food and Drug Administration (FDA) placed a black-box warning for Shingrix, a non-live recombinant vaccine against the varicella-zoster virus, regarding a possible risk of acquiring GBS post-vaccination in adults aged 65 and older. We report the recurrence of a rare subtype of GBS in a 61-year-old patient following the second dose of Shingrix. This case highlights the difficulty of diagnosing and treating recurrent GBS. It also raises awareness that Shingrix may be related to the development of GBS in younger patients. This case also emphasizes the importance of differentiating GBS from other polyneuropathies.

Serious and Progressive Neuropathy Presumably Post-Shingrix Vaccination

“…This patient experienced recurrent bouts of rigors, weakness, and gait instability. He achieved a full recovery after plasma exchange but had a recurrent episode 10 months later [13].…”

“…Another case report involved a 79-year-old male who developed GBS 10 days after receiving Shingrix. He was successfully treated with IVIG [13].…”

“…In response to these reports and the phase 3 trial findings, the FDA issued a black-box warning for Shingrix in 2021 regarding the potential risk of GBS following vaccination [13]. Previous reports have also documented cases of GBS following Shingrix administration, including a case of an elderly male who developed the rare acute motor sensory axonal neuropathy (AMSAN) variant of GBS.…”

Plasma exchange (PE) versus intravenous immunoglobulin (IVIG) for the treatment of Guillain-Barré syndrome (GBS) in patients with severe symptoms: A systematic review and meta-analysis

“…Research shows that it has a global incidence rate of 1–2 per 100,000 people yearly and affects people of all age groups [ 3 ]. However, it is slightly more common among males than females [ 4 , 5 ].…”