Disclosures: Jason Lew, DO: No financial relationships or conflicts of interest

Case Diagnosis: Acute inflammatory demyelinating polyneuropathy following influenza vaccination

Case Description or Program Description: A 73-year-old male with history of chronic myeloid leukemia on dasatinib and alcohol abuse, who presented with numbness and weakness in all four extremities. Patient received the influenza vaccine then initially developed bilateral hands numbness which progressed to his bilateral feet two weeks later. Patient had previously received multiple influenza vaccinations without any complications. He subsequently experienced a new left facial droop and numbness. Patient was diagnosed with Bell’s Palsy and discharged home. His weakness continued to progress and he started using a wheelchair for mobility compared to no device at baseline. He was admitted for suspected acute inflammatory demyelinating polyneuropathy after negative MRI brain and cervical spine. He received IVIG with mild improvements of strength.

Setting: Outpatient Physiatry Clinic

Assessment/Results: Sensory conduction studies of bilateral sural, right median, and right superficial radial nerves were absent. Motor conduction studies of bilateral common peroneal and tibial nerves showed significantly increased onset latency and decreased conduction velocity with temporal dispersion, while the distal amplitudes were decreased to a lesser extent. Bilateral tibial F waves had increased minimum latency and decreased persistence. Motor conduction of right ulnar nerve had significantly increased onset latency and decreased conduction velocity in a patchy distribution with temporal dispersion. Needle EMG was unremarkable except for 1+ fibrillations and positive sharp waves in the right gastrocnemius. Electrodiagnostic studies were consistent with AIDP (acute inflammatory demyelinating polyneuropathy).

Discussion (relevance): AIDP generally presents as ascending numbness and weakness rather than descending as seen in this case. Some studies show association between AIDP and influenza vaccination, however cases are very rare, suspected to be around 1-2 cases per million.

Conclusions: This case demonstrates an unusual presentation of AIDP following an influenza vaccine. Due to the unusual presentation, initial diagnosis was delayed, however was confirmed on electrodiagnostic testing with hallmark signs of AIDP.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-unusual-presentation-of-acute-inflammatory-demyelinating-polyneuropathy-following-influenza-vaccination/