Pérez NJ

Language: Spanish
References: 13
Page: 398-402
PDF size: 31.25 Kb.

ABSTRACT

Introduction: neuralgic amyotrophy or Parsonage-Turner syndrome is associated with vaccination in 15% of cases. There are no reports linking this condition to the vaccine against human leptospirosis.
Objective: describe the clinical characteristics of a patient who developed acute brachial plexopathy after vaccination against human leptospirosis.
Case presentation: a male 31 year-old agricultural worker received a dose of the Cuban vaccine against human leptospirosis (vax-SPIRAL) in 2008. Three weeks later he presented intense pain in both shoulders. The following week he had muscular weakness, and then atrophy of the right deltoid muscle. Neurological evaluation showed acute asymmetric damage to the upper brachial plexus, with greater intensity on the right side, and involvement of the diaphragm. Nerve conduction examination and electromyography revealed involvement of the upper brachial plexus. The patient was treated with analgesics and physical therapy, and was found to evolve favorably.
Conclusions: the events described suggest that the Cuban vaccine against human leptospirosis might produce immunological cross-reactivity against antigens of the peripheral nervous system.

REFERENCES

1. Arguelles JL, Rojas JO, Herrera D. Presentación inusual del síndrome de Parsonage-Turner. Reporte de un caso. Revista Científica Medisur. 2011;9(6):59-61.

2. Moghekar AR, Moghekar AR, Karli N, Chaudhry V. Brachial plexopathies: etiology, frequency, and electrodiagnostic localization. J Clin Neuromuscul Dis. 2007;9:243-7.

3. Fernández E, Montesinos S, Diez C. Sídrome de Parsonage-Turner. Rev Atención Primaria. 2007;39(11):622.

4. Perez de la Cruza S. Síndrome de Parsonage-Turner en la infancia y adolescencia. Caso clínico. Archivos Argentinos Pediatr. 2012;110(5):3.

5. Martínez R, Pérez A, Quiñones MC, Cruz R, Álvarez A, Armesto M, et al. Eficacia y seguridad de una vacuna contra la leptospirosis humana en Cuba. J Public Health. 2004;15(4):249-55.

6. Martínez R, Obregón AM, Pérez A, Baly A, Díaz M, Baró M, et al. Reactogenicidad e inmunogenicidad de la primera vacuna cubana contra la leptospirosis humana. Rev Cubana Med Trop. 1998;50(2):159-66.

7. Obregón AM, Martínez G, Martínez R, Llop A, Rodríguez I, Rodríguez J, et al. Respuesta serológica por ELISA y MAT en voluntarios cubanos vacunados con vaxSPIRAL. Rev Cubana Med Trop. 2004;56(2):148-51.

8. van Alfen N. Clinical and pathophysiological concepts of neuralgic amyotrophy. Nat Rev Neurol. 2011;107(6):315-22.

9. Suarez GA, Giannini C, Bosch EP. Immune brachial plexus neuropathy: suggestive evidence for an inflammatory-immune pathogenesis. Neurology. 1996;46:559-61.

10. Costa F, Martinez-Silveira MS, Hagan JE, Hartskeerl RA, Reis MG, Ko AI. Surveillance for leptospirosis in the Americas, 1996-2005: a review of data from ministries of health. Rev Panam Salud Publica. 2012;32(3):169-77.

11. Dirección Nacional de Estadística (CU). Estadísticas de salud. Series de tiempo de morbilidad. Casos notificados por leptospirosis según grupos de edad: Cuba 1978-2011. Habana: DNE; 2011 [citado 1 Ene 2013]. Disponible en: http://www.sld.cu/galerias/doc/sitios/dne/leptospirosis_1970-2011.doc

12. Odell JA, Kennelly K, Stauffer J. Phrenic nerve palsy and Parsonage-Turner syndrome. Ann Thorac Surg. 2011;92(1):349-51.

13. van Alfen N, van Engelen BGM, Hughes RAC. Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis). Cochrane Database Systematic Reviews. 2009; Issue 3:Art. No. CD006976.