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Koh EJ, Tan KN, Chan ZW, Candice Wong HY, Chin ML, Lee TC. A New Association Of Guillain Barre Syndrome In A Patient With Central Nervous System Melioidosis. J Ayub Med Coll Abbottabad 2023; 35:334-336. [PMID: 37422834 DOI: 10.55519/jamc-02-11470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Burkholderia pseudomallei affecting the central nervous system has been extensively reported in the literature. However, combined central nervous system and peripheral nervous system involvement in melioidosis has never been reported. We report a 66-year-old man with diabetes mellitus who was diagnosed to have central nervous system melioidosis and developed acute flaccid quadriplegia. Nerve conduction studies and anti-ganglioside antibodies were consistent with Guillain-Barre syndrome. This case report highlights the importance to recognise the possibility of Guillain Barre syndrome complicating central nervous system melioidosis and stresses the urgency of early consideration of this complication, as early immunomodulatory therapy may hasten neurological recovery.
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Affiliation(s)
- Ewe Jin Koh
- Department of Internal Medicine, Hospital Taiping, Perak, Malaysia
| | - Kah Nian Tan
- Department of Internal Medicine, Hospital Taiping, Perak, Malaysia
| | - Zhi Wei Chan
- Department of Internal Medicine, Hospital Taiping, Perak, Malaysia
| | | | - Ming Lee Chin
- Department of Medicine and Paediatrics, Hospital Taiping, Perak, Malaysia
| | - Tiong Chan Lee
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
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Al‐Ameen O, Faisal M, Mustafa S, Alhatou M. Atypical Guillain-Barre syndrome with T6 sensory level. Clin Case Rep 2022; 10:e6414. [PMID: 36245439 PMCID: PMC9547346 DOI: 10.1002/ccr3.6414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
Guillain-Barré syndrome is an acute immune-mediated demyelinating disease. Typical features include progressive ascending lower extremity weakness and areflexia. Several variants have been described that can make the diagnosis challenging. Here, we report a case of GBS presenting with progressive lower limb weakness and T6 sensory level.
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Affiliation(s)
- Osamah Al‐Ameen
- Department of Medical EducationHamad Medical CorporationDohaQatar
| | - Mohanad Faisal
- Department of Medical EducationHamad Medical CorporationDohaQatar
| | - Salma Mustafa
- Department of Medical EducationHamad Medical CorporationDohaQatar
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El aidouni G, Touihar S, Merbouh M, Aabdi M, El Kaouini A, Bouabdallaoui A, Es-Saad O, Bkiyar H, Housni B. Guillain Barre syndrome as a complication of SARS-CoV-2 infection: A case report. Ann Med Surg (Lond) 2021; 68:102672. [PMID: 34377452 PMCID: PMC8340561 DOI: 10.1016/j.amsu.2021.102672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Covid-19 infection usually manifests with respiratory symptoms, but neurological signs might be the mean symptom revealing this infection such as Guillain Barre syndrome (GBS). COVID-19 associated GBS seems to be more severe than non-COVID-19 GBS. Case management We reported a 49 old-man admitted in the intensive care unit for bilateral ascending symmetrical paresthesia associated with lower limb numbness and sphincter disorders two weeks after an upper respiratory infection. The diagnosis of post-Covid-19 GBS was maintained, and the evolution was favorable after Intravenous Immunoglobulin (IVIg) and plasma exchange (PLEX) as a second therapy. Conclusion This case report suggest the probable causal link between COVID 19 and GBS. This severe association prompts us to do further research that may help professionals in an early diagnosis and early treatment thus improving morbidity and mortality. Infections due to Covid-19 are represented mainly by respiratory symptoms. Guillain barre syndrome has been mentioned as a rare sequela occurring usually after viral infection. This case report suggest the probable causal link between COVID 19 and GBS. COVID-19 associated GBS it seems to be more severe than non-COVID-19 GBS.
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Affiliation(s)
- Ghizlane El aidouni
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
- Corresponding author. Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.
| | - Salma Touihar
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Manal Merbouh
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Mohammed Aabdi
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Abderrahim El Kaouini
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Amine Bouabdallaoui
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Ounci Es-Saad
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Houssam Bkiyar
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Brahim Housni
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
- Mohammed First University, FMP Oujda, LAMCESM, 60000, Oujda, Morocco
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Sangani V, Pokal M, Balla M, Merugu GP, Adapa S, Naramala S, Konala VM. Pembrolizumab related Guillain barre syndrome, a rare presentation in a patient with a history of lupus and bladder cancer. J Community Hosp Intern Med Perspect 2021; 11:388-392. [PMID: 34234913 PMCID: PMC8118446 DOI: 10.1080/20009666.2021.1903133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Immune checkpoint inhibitor-related neurotoxicity causing Guillain Barre Syndrome is relatively uncommon. We discussed an 80-year-old patient with known systemic lupus erythematosus who presented with lower extremity weakness, areflexia and then progressed to respiratory muscle and upper extremity weakness after receiving immunotherapy with checkpoint inhibitors for metastatic bladder cancer. With the increasing use of immunotherapy for the management of cancer, awareness of neurological autoimmune side effects is essential. Immune checkpoint inhibitor-mediated GBS can be severe and fatal if not diagnosed promptly. The hospitalists, neurologists, and oncologists should be aware of neurotoxicity related to immune checkpoint inhibitor therapy requiring a multidisciplinary approach to patient care. Prompt initiation of immunosuppressive therapy is required for the management of immune checkpoint inhibitor-related neurotoxicity.
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Affiliation(s)
- Vikram Sangani
- Hospitalist, Department of Internal Medicine, Quantum HC, Macon, Georgia
| | - Mytri Pokal
- Hospitalist, Department of Internal Medicine, Quantum HC, Macon, Georgia
| | - Mamtha Balla
- Clinical Assistant Professor, Department of Internal Medicine, University of Toledo and Promedica Toledo Hospital, Toledo, USA
| | - Ganesh Prasad Merugu
- Division Chief and Geriatric Fellowship Program Director, Division of Geriatric Medicine, Department of Family Medicine, University of Toledo, Toledo, USA
| | - Sreedhar Adapa
- Department of Internal Medicine, Division of Nephrology, Adventist Medical Center, Hanford, USA
| | - Srikanth Naramala
- Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, USA
| | - Venu Madhav Konala
- Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, USA
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Morena J, Elsheikh B, Hoyle JC. Recurrent Miller Fisher: A Case Report Along With a Literature and an EMG/NCS Review. Neurohospitalist 2021; 11:263-266. [PMID: 34163555 DOI: 10.1177/1941874420987053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
MFS has been reported to recur in 10-12% of patients. There may be a genetic component related to HLA-DR2. Anti-GAD antibodies can be present in MFS along with anti-GQ1b. Common EMG/NCS associations consist of a predominantly axonal, sensory polyneuropathy and absent H reflexes. A 32-year-old female with a history of hypothyroidism presented to our institution twice with symptoms of diplopia, lower extremity weakness and distal paresthesias occurring a year apart. She had ophthalmoplegia, reduced reflexes, and ataxia on exam. CSF showed a borderline elevated protein of 47 and white blood cells <3. She was positive for anti-GQ1b both times. Her anti-GAD65 antibody was elevated during both admissions. EMG/NCS on her first admission revealed comparatively reduced sensory nerve action potentials (SNAPs) and a normal blink reflex. Her SNAPs improved on the second admission, however, the EMG was performed only 2 days after the onset of her symptoms, limiting some early findings that may have not matured electrophysiologically. She was treated with IVIG on both occasions with rapid recovery within 5 days. This case highlights the fact that MFS can be recurrent. It also provides further evidence that anti-GAD antibodies may be associated with MFS. Reported findings of the blink reflex in MFS are diverse and further data is needed to determine if certain findings are more predominant than others. Treatment typically consists of IVIG, though steroids may also be considered for recurrence. Prognosis is generally favorable, regardless of treatment.
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Affiliation(s)
- Jonathan Morena
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Bakri Elsheikh
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - J Chad Hoyle
- Department of Neurology, The Ohio State University, Columbus, OH, USA
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Dufour C, Co TK, Liu A. GM1 ganglioside antibody and COVID-19 related Guillain Barre Syndrome - A case report, systemic review and implication for vaccine development. Brain Behav Immun Health 2021; 12:100203. [PMID: 33462567 PMCID: PMC7805391 DOI: 10.1016/j.bbih.2021.100203] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/16/2022] Open
Abstract
Background Guillain Barre Syndrome (GBS) and Miller Fisher Syndrome (MFS) are emerging as known consequences of COVID-19 infection. However, there have been no reported cases with positive GM1 or GQ1b antibodies in the literature to date. Although clinically similar, the pathophysiology of COVID-19 related GBS and MFS may be significantly different from cases in the pre-pandemic era. Case presentation We present a patient with ascending areflexic weakness consistent with GBS with positive GM1 antibody. The patient had recovered from COVID-19 infection two weeks prior with mild viral illness and symptoms. Her weakness was isolated to the lower extremities and improved after intravenous immunoglobulin treatment. Patient recovered eventually. Conclusions – The general lack of reported ganglioside antibodies supports a novel target(s) for molecular mimicry as the underlying etiology, which raises the concern for possible vaccine induced complication. Whether the current GM1 positive case is a sequalae of COVID-19 or a mere coincidence is inconclusive. Further understanding of the disease mechanism of pandemic era GBS and MFS, including antigen target(s) of COVID-19, may be of utmost importance to the development of a safe COVID-19 vaccine.
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Affiliation(s)
- Catherine Dufour
- Neurology, Adventist Health White Memorial, 1720 Cesar Chavez Avenue, Los Angeles, CA, 90033, USA
| | - Thien-Kim Co
- Neurology, Adventist Health White Memorial, 1720 Cesar Chavez Avenue, Los Angeles, CA, 90033, USA
| | - Antonio Liu
- Neurology, Adventist Health White Memorial, 1720 Cesar Chavez Avenue, Los Angeles, CA, 90033, USA
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Wijekoon PW, Bandara KA, Kailainathan A, Chandrasiri NS, Hapuarachchi CT. Guillaine-barre syndrome; a rare complication of melioidosis. a case report. BMC Infect Dis 2016; 16:388. [PMID: 27506202 DOI: 10.1186/s12879-016-1719-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/15/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Melioidosis caused by Burkholderia pseudomellei is an infection with protean clinical manifestations. Guillain-Barré syndrome [GBS] associated with melioidosis is very rare. CASE PRESENTATION A 42-year-old woman with diabetes presented with abdominal pain, vomiting and intermittent fever for one month. Six months before presentation she had recurrent skin abscesses. Three months before presentation she had multiple liver abscesses which were aspirated in a local hospital. The aspirate grew "coliforms" resistant to gentamicin and sensitive to ceftazidime. On presentation she had high fever and tender hepatomegaly. Ultra Sound Scan of abdomen showed multiple liver and splenic abscesses. Based on the suggestive history and sensitivity pattern of the previous growth melioidosis was suspected and high dose meropenem was started. Antibodies to melioidin were raised at a titre of 1:10240. The growth from the aspirate of liver abscess was confirmed as Burkholderia pseudomellei by polymerase chain reaction [PCR]. After a week of treatment, patient developed bilateral lower limb weakness. Deep tendon reflexes were absent. There was no sensory loss or bladder/bowel involvement. Analysis of the cerebro-spinal fluid showed elevated proteins with no cells. There was severe peripheral neuropathy with axonal degeneration. A diagnosis of GBS was made and she was treated with plasmapharesis with marked improvement of neurological deficit. Continuation of intravenous antibiotics lead to further clinical improvement with normalization of inflammatory markers and resolution of liver and splenic abscess. Eradication therapy with oral co-trimoxazole and co-amoxyclav was started on the seventh week. Patient was discharged to outpatient clinic with a plan to continue combination of oral antibiotics for 12 weeks. At the end of 12 weeks she was well with complete neurological resolution and no evidence of a relapse. CONCLUSIONS Guillaine Barre syndrome is a rare complication of melioidosis and should be suspected in a patient with melioidosis who develop lower limb weakness. Plasmapharesis can be successfully used to treat GBS associated with active melioidosis.
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