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Acute Sensory Neuropathy with Small and Large Nerve Fibre Involvement After Vaccination for Influenza Virus: a Rare Sensory Guillain–Barre variant? A Case Report

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Abstract

Guillain-Barré syndrome (GBS) refers to an acute autoimmune peripheral neuropathy spectrum with various subtypes. It is mostly developed by patients after infections and, in rare cases, after immunization by vaccination. The aim of our paper is to report a very rare case of acute sensory small and large fibre neuropathy after vaccination for influenza virus. We report the case of a 55-year-old male patient presenting with signs of acute distal sensory loss of temperature and pain. He reported no symptoms of respiratory, urinary or gastrointestinal tract infection within the last 6 months, but vaccination for influenza virus 3 weeks ago. His examination revealed distal sensory loss of pain and temperature in all extremities, abnormal proprioception in lower limbs normal muscle strength, and brisk tendon reflexes. Lumbar puncture revealed albuminocytological dissociation and lumbosacral Magnetic Resonance Imaging with gadolinium demonstrated enhancement of lumbosacral roots. Sympathetic skin response and quantitative sensory testing indicated small nerve fibres involvement. He was treated with high doses of intravenous methylprednisolone and immunoglobulin, and complete recovery was reported within 2 months. The clinical course, neurophysiological and radiological findings indicate that our case joins the spectrum of GBS variants, providing additional information to the existing literature and contributing to the classification and knowledge of pure sensory Guillain–Barre syndrome and related disorders.

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Further anonymized data can be made available to qualified investigators upon request to the corresponding author.

Abbreviations

SFN:

Small fibre neuropathy

GBS:

Guillain-Barre syndrome

MRI:

Magnetic resonance imaging

SNAP:

Sensory nerve action potential

SSR:

Sympathetic skin response

QST:

Quantitative sensory testing

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Acknowledgements

The authors would like to thank our patient for providing us his informed consent for publishing this manuscript and images. We would also like to thank Dr Tzartos Ioannis of Tzartos Neurodiagnostics for processing serum specimen for antibodies to gangliosides and paraneoplastic antibodies.

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Authors and Affiliations

  1. Department of Neurology, Evangelismos General Hospital, Ipsilantou 45-47, 10676, Athens, Attiki, Greece

    Michail Papantoniou, Dimitrios Pitidis-Poutous, Antonios Tavernarakis & Dimitrios Karakalos

  2. Laboratory of Clinical Neurophysiology, A Neurological Clinic, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Michail Papantoniou & Panagiotis Kokotis

Authors
  1. Michail Papantoniou
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  2. Panagiotis Kokotis
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  3. Dimitrios Pitidis-Poutous
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  4. Antonios Tavernarakis
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  5. Dimitrios Karakalos
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Contributions

M.P. wrote the manuscript. P.K performed QST and revised the manuscript; M.P., D. P., T.A. and D.K. were responsible for patient’s clinical course and revised the paper.

Corresponding author

Correspondence to Michail Papantoniou.

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Ethics Approval

This study was approved by the Scientific Committee of Evangelismos Hospital.

Consent for Publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

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The authors declare no competing interests.

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Papantoniou, M., Kokotis, P., Pitidis-Poutous, D. et al. Acute Sensory Neuropathy with Small and Large Nerve Fibre Involvement After Vaccination for Influenza Virus: a Rare Sensory Guillain–Barre variant? A Case Report. SN Compr. Clin. Med. 5, 100 (2023). https://doi.org/10.1007/s42399-023-01444-w

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