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Translation of a-t 2022; 53: 72


Neuralgic amyotrophy of the shoulder following vaccination with the inactivated shingles vaccine SHINGRIX

A 78-year-old woman developed mild neck pain two days after vaccination with the inactivated herpes zoster vaccine SHINGRIX in the left deltoid muscle. A few hours later, she experienced an attack of severe pain in her shoulder, which affected, however, the right side of her body. Taking 1,000 mg metamizole (NOVALGIN, generics) had no effect. Tests in the clinic two hours later were unable to clarify the source of the pain. Three days after the start of the pain, the patient noticed a weakness in her right shoulder. A neurological examination was carried out and she was diagnosed with paresis of the right deltoid muscle as part of neuralgic amyotrophy (PARSONAGE-TURNER syndrome). An MRI showed evidence of possible inflammatory changes in the C5 nerve root on the right-hand side. The pain only permanently improved after the start of short-term highdose of glucocorticoid treatment. Three weeks after the acute event the patient was pain-free and the paresis had improved significantly (NETZWERK report 18.403). A similar event was reported to us more than 15 years ago in connection with the tick-borne encephalitis vaccine ENCEPUR (no longer marketed, a successor preparation is currently being sold under this trade name): a 42-year-old woman experienced acute severe pain in her right shoulder and mild pain in her left shoulder four weeks after a booster in her upper left arm. Shortly after this she experienced paralysis of the right arm and a feeling of numbness over her right shoulder. A subsequent neurological examination showed paresis on both sides in the region of the shoulder girdle (13.438). A rare* neuropathy occurring on one side or sometimes both sides that typically manifests as sudden and massive shoulder, neck or upper arm pain which generally results in paralysis in the area supplied by the brachial plexus after several hours or days is referred to as neuralgic amyotrophy of the shoulder. Patients often also experience sensory disturbance (1,2). Unlike in patients with radiculopathy, the symptoms are often not limited to the supply area of a nerve root. The precise cause is unknown. An autoimmune process is under discussion (1). According to a case series with 246 patients, the pain mostly cannot be managed with conventional analgesics such as non-steroidal anti-inflammatory drugs alone. An event such as an infection, surgery or a vaccination before the start of the symptoms is described in around half of those affected (2). The neuropathy has been reported in the literature in close chronological connection with vaccinations against COVID-19 (3), influenza (4) and human papillomaviruses (5), in some cases (as in the current NETZWERK report) on the opposite side of the body to the one in which the vaccine was received (6,7). In rare cases, nerves outside of the brachial plexus could also be affected, e.g. the phrenic nerve, cranial nerves or the lumbosacral plexus (1). There may also be no pain (2,7).

* Based on previous estimations the incidence is around 1-3/100,000/year (1,3). An observational study (8) showed an incidence of 1/1,000/year.
1GSTOETTNER, C. et al.: J. Neurol. Neurosurg. Psychiatry 2020; 91: 879-88
2Van ALFEN, N., Van ENGELEN, B.G.M.: Brain 2006; 129: 438-50
3GHIDOSSI, S. et al.: Swissmedic Vigilance-News, June 2021; 26: 11-4; https://a-turl.de/xgui
4SHAIKH, M.F. et al.: BMJ Case Rep. 2012; 2012: bcr 2012007673 (2 pages)
5TARAS, J.S. et al.: Hand (N.Y.) 2011; 6: 454-6
6QUELER, S.C. et al.: Radiology 2022; 302: 84-7
7DIAZ-SEGARRA, N. et al.: PM R 2022; 14: 889-91
8Van ALFEN, N. et al.: PLOS ONE 2015; 10: e0128361 (9 pages)

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