Guillan Barre
Question:
11/16/2017
22 y/o female w/ family h/o autoimmune disease. Being evaluated for functional antibody deficiency. Slightly decreased IgA. Family h/o Guillain Barre syndrome with Prevnar (grandmother). Have checked w/ CDC and found reports of GBS w/Prevnar, pneumovax, and meningococcal. Family does not vaccinate with any type of pneumococcal vaccine. What vaccine should I use to evaluate?
Answer:
As you know Guillain-Barre is an acute inflammatory demyelinating polyneuropathy typically presenting after an infectious illness, most commonly Campylobacter jejuni. GB is considered to be a complex multifactorial disorder with both genetic and environmental factors rather than a disorder following simple mendelian inheritance. While GBS is not a hereditary disease there have been rare familial occurrences. While you are correct that GB has been noted to occur after pneumococcal vaccination (http://clinicsinsurgery.com/pdfs_folder/cis-v2-id1413.pdf) I was not able to identify any article(s) that describe any specific risk factors that could be identified with GB after Prevnar in a family member two generations removed from your patient.
This is an excellent review of GB : Hugh J Willison, Bart C Jacobs, Pieter A van Doorn Guillain-Barré syndrome Lancet 2016; 388: 717–27.
I hope this has been helpful.
Andrew Murphy, MD, FAAAAI