Guillain-Barré syndrome following oral cholera vaccination: a case report in an elderly patient

Abstract

Guillain-Barré Syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy often triggered by infections and, more rarely, vaccinations. Although the oral cholera vaccine is considered safe, reports of neurological complications remain extremely rare. This case highlights a severe presentation of GBS occurring shortly after cholera vaccination. A 68-year-old previously healthy male developed ascending weakness and numbness in the hands over seven days, with dysarthria developing two days before admission. His symptoms developed following recent oral cholera vaccination. Examination revealed bilateral facial palsy, global hypotonia, areflexia, and progressive limb weakness. Despite early initiation of intravenous immunoglobulin, his neurological function rapidly deteriorated, reaching a nadir of 0/5 strength in the lower limbs. Progressive respiratory compromise necessitated elective intubation on day 4 and tracheostomy on day 6. His hospital course was further complicated by delirium. Clinical improvement began on day 11, and he was extubated the same day. After 26 days of hospitalization, he was discharged with a GBS disability score of 4 and transferred for rehabilitation. Follow-up showed steady recovery, with independent ambulation achieved by 45 days post-discharge. This case describes a severe, rapidly progressive form of GBS temporally associated with oral cholera vaccination. Although a causal relationship cannot be inferred, the case contributes to the limited literature regarding potential neurological events occurring after vaccination and underscores the importance of continued pharmacovigilance.