Current Department of Health (UK) guidelines suggest that all people aged over 65 years should receive annual influenza vaccination. There is a range of adverse medical sequelae associated with this. Two serious complications are Guillain-Barré syndrome¹ and systemic vasculitis.^2,3 The strength of association between influenza vaccination and Guillain-Barré syndrome has been questioned, and little is known of the pathogenesis.³ Several investigators have reported a close temporal association between influenza vaccination and systemic vasculitis of various classifications.^2,3 Vasculitic peripheral neuropathy was not a feature in any of the reported cases.^2,3

We report a case of biopsy proven vasculitis, presenting as mononeuritis multiplex, following influenza vaccination. The clinical picture evolved rapidly into a syndrome indistinguishable from axonal Guillain-Barré syndrome. This suggests a differential diagnosis for post-vaccination neuropathy, with implications for management. We believe this is the first report in which there was an associated peripheral neuropathy at presentation. It raises issues about the aetiology and pathogenesis of vaccination associated neuropathy.

Case report

A previously fit and active 72 year old woman was admitted after routine influenza vaccination. She gave a history of progressive distal arm and leg …