Inflammatory polyradiculoneuropathy with spinal cord involvement and letal outcome after hepatitis B vaccination

• Published in: Journal of the neurological sciences 2001-05, Vol.186 (1), p.81-85
• Main Authors: Sindern, E., Schröder, J.M., Krismann, M., Malin, J.P.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Drug toxicity and drugs side effects treatment; Guillain–Barré syndrome; HB SAg/anti-HB SAg; Hepatitis B-vaccination; Involvement of the anterior horn; Medical sciences; Molecular mimicry; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Myeloradiculoneuritis; Neurology; Neuropathology; Pharmacology. Drug treatments; Toxicity: nervous system and muscle
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/S0022-510X(01)00510-X

We report on a 36-year-old man who developed an inflammatory polyradiculoneuropathy similar to Guillain-Barré syndrome 9 days after hepatitis B vaccination. Extensive immunotherapy including immunoglobulins, steroids, plasmapheresis, cyclophosphamide and methotrexate did not stop the progressive course of the disease and the patient died 4 months later due to multiorgan failure with septic shock symptoms and adult respiratory distress syndrome (ARDS). The neuropathological investigation showed severe axonal loss with mild demyelination of peripheral nerves and mononuclear cell infiltrates, predominantly T-lymphocytes, in nerve roots and spinal ganglia. In addition, there were unusual, perivascular and parenchymal lymphocytic cell infiltrates in the grey matter, especially the anterior horns of the spinal cord. The temporal relationship to hepatitis B vaccination, the strong increase of HBs-antibodies within 3 weeks after vaccination, and the presumptive immune mediated pathology of this disorder suggest a possible etiologic link with hepatitis B vaccine.