Rare Twist: Post-rabies Vaccine Guillain-Barré Syndrome Unveiled

Guillain-Barre syndrome is an autoimmune neurological disorder characterized by rapid worsening weakness, often starting in the legs and spreading upward. Guillain-Barre syndrome is usually preceded by respiratory or gastrointestinal infections. Two-thirds of cases of Guillain-Barre syndrome are diagnosed following infection; however, vaccination has also been linked to Guillain-Barre syndrome pathogenesis. The most commonly known etiology of Guillain-Barre syndrome is an infectious disease notably caused by Campylobacter Jejuni. A very small fraction of people can develop Guillain-Barre syndrome due to vaccines such as meningococcal, poliovirus, influenza, and rabies. Vaccine-associated Guillain-Barre syndrome is defined as those with the onset of Guillain-Barre syndrome symptoms within six weeks after receiving the vaccine. Among the vaccines associated with Guillain-Barré Syndrome, one is for rabies. Given the invariably fatal nature of rabies, post-exposure prophylaxis should be administered in accordance with World Health Organization guidelines. There are two types of vaccines globally available to protect against rabies in humans; which are Nerve Tissue Vaccine 2 (NTV) and Cell Culture Vaccine (CCV). Even though, the World Health Organization has strongly recommended discontinuing the Nerve Tissue Vaccine and replace with the modern cell culture-derived vaccine, a few low-income countries including Ethiopia are still using the vaccine as post-exposure prophylaxis following rabies exposure, because of the affordability and accessibility problems related to modern cell culture vaccines. The vaccine has been predominantly used in Ethiopia since 1944. We are reporting a 22-year-old Ethiopian woman who presented with a progressive weakness for six days. The weakness initially started from the lower limb. It progressed caudally after she had received 12 doses of the Nerve Tissue anti-rabies vaccine, which was administered following a dog bite to her right lower extremity.