Post influenza vaccination Guillain-Barré syndrome. An exceptional recovery case after cardiac arrest for two hours in hyperthermia and septic shock

Abstract

Autonomic dysfunction is a frequent and severe complication of Guillaine-Barré syndrome (GBS). It is often responsible for cardiovascular abnormalities, even cardiac arrest, but prediction of these complications is difficult. We describe the case of a 77-year-old woman admitted to Intensive Care Unit for acute respiratory failure and loss of consciousness of unknown nature.The diagnosis of post-influenza vaccination GBS was delayed due to the difficulty in collecting anamnestic data. The patient was treated with IV immunoglobulin but the clinical picture was complicated by hyperthermia, cardiac arrest and septic shock. After 122 min of CPR, blood pressure was restored to 98/40 mmHg and sinus tachycardia at 130beats/min with negative T-wave in precordial leads. Neurologically the patient showed CGS 3. The persistent hemodynamic instability, fever, and high values of inflammatory markers led to the diagnosis of septic shock. Coupled Plasma Filtration Adsorption(CPFA) was immediately carried out with high volume of treated plasma. On 36th day the patient was discharged conscious, able to move spontaneously all limbs and without any sensory or motor deficit. This case is unique due to complete recovery of the patient after cardiopulmonary resuscitation (CPR) for more than two hours in hyperthermia, and it has never been described before. We emphasize that the use of an aggressive rescue therapy like CPFA in a comatose patient undergoing CPR for over 2 hours in hyperthermia can be helpful in elderly patients too.It is prudent to establish rapid diagnosis, and consider neurological signs and symptoms in the context of a recent vaccination.