A Rare Presentation of Narcolepsy With Cataplexy After Vaccines in a Genetically Susceptible Elderly Woman: A Case Report

Observing cataplexy episodes during an office visit is extremely rare as they are usually triggered by laughter or emotional stress. Narcolepsy usually occurs in the younger population. We report a case of a 65-year-old Caucasian female with a past medical history of obesity who developed excessive...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-06, Vol.15 (6), p.e40997
Main Authors: Verma, Ram K, Prasad, Vinita, Rath, Subhendu, Monga, Varun, Dhillon, Gagandeep
Format: Article
Language:English
Subjects:
Antibodies
Body mass index
Case reports
Cognition & reasoning
Continuous positive airway pressure
Coronaviruses
COVID-19
Eye movements
Fatigue
Hallucinations
Influenza
Internal Medicine
Kinases
Neurology
Older people
Oxygen saturation
Patients
Pulmonology
Sleep apnea
Sleep disorders
Vaccines
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Summary:Observing cataplexy episodes during an office visit is extremely rare as they are usually triggered by laughter or emotional stress. Narcolepsy usually occurs in the younger population. We report a case of a 65-year-old Caucasian female with a past medical history of obesity who developed excessive daytime sleepiness, fatigue, and sleep attacks five weeks after getting influenza and pneumococcal vaccines. The presentation of cataplexy was atypical. Several episodes of cataplexy were observed during the office visit without any emotional trigger. Further workup, including polysomnography (PSG), was positive for obstructive sleep apnea, controlled with continuous positive airway pressure (CPAP) use. Later, she had PSG with CPAP use, which optimally controlled obstructive sleep apnea, followed by multiple sleep latency tests (MSLT) with CPAP use. It was positive for narcolepsy with a mean sleep latency of 1.6 minutes with sleep onset rapid eye movement (REM) in five out of five naps. Her cerebrospinal fluid (CSF) hypocretin level was extremely low at 50 pg/ml, usually seen in narcolepsy with cataplexy. She was also positive for human leukocyte antigen (HLA) DBQ1*06:02. The diagnosis of narcolepsy with cataplexy was made, which improved with medications for narcolepsy.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.40997