Anti-GM1 IgM antibody positive axonal variant of Guillain-Barre-syndrome in a pediatric patient with dengue fever

Prado, Mario B.; Narito, Karla M.; Adiao, Karen Joy

doi:10.1016/j.jneuroim.2021.577572

Cited by 8 publications

(8 citation statements)

References 10 publications

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“…[7][8][9][10] To evaluate for an axonal GBS variant, anti GM1 antibodies were tested. 5 As these were negative, we suspect that our patient had acute inflammatory demyelinating polyneuropathy. Other differentials include neoplasms such as leukemias and lymphomas which may also affect the facial nerves, but these usually present less rapidly and with similar involvement of the 8 th cranial nerve.…”

Section: Discussionmentioning

confidence: 85%

“…The normal NCS of both the initial and repeat studies supports the absence of limb involvement. 5 Although the ACD implies polyradiculoneuropathy, the location of the facial nerve's involvement in the subarachnoid space may elevate the albumin in the CSF in the background of normal white blood cell count. 6 Several cases have been reported with facial diplegia as the initial manifestation of GBS, most of them however, were eventually followed by symmetric ascending limb weakness and hyporeflexia, which are absent in our patient.…”

Section: Discussionmentioning

confidence: 99%

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Facial Diplegia as the Sole Manifestation of Post-Vaccination Guillain-Barre Syndrome: A Case Report and Literature Review

Prado

Adiao

2022

The Neurohospitalist

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Introduction: Recently, a large study concluded that certain brands of vaccines may increase the risk of Bell’s palsy and Guillain Barre Syndrome (GBS). As to whether vaccination after COVID-19 modify the risk of Bell’s palsy or GBS has not yet been studied. Case: Here we report a 35 years old COVID-19 survivor whom in less than 2 weeks after his second dose of inactivated SARS-CoV2 vaccine, developed bilateral facial nerve paralysis. In addition, he had hyperacusis, dysgeusia and decreased lacrimation without any signs of sensory and motor deficits in the limbs. His limb nerve conduction study (NCS) was unremarkable in contrast to bilaterally abnormal facial NCS and blink reflexes. Although he had negative anti-GM1 IgG and IgM antibodies, he has marked albuminocytologic dissociation, classic of acute inflammatory demyelinating polyneuropathy. Conclusion: To date, there were no similar case reports which published the occurrence of facial diplegia as sole manifestation of GBS in a post COVID-19 patient who recently completed vaccination. We believe that molecular mimicry, induced by magnified immune response from both COVID-19 and vaccination may have caused the symptom.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Facial Diplegia as the Sole Manifestation of Post-Vaccination Guillain-Barre Syndrome: A Case Report and Literature Review

Prado

Adiao

2022

The Neurohospitalist

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“…Subsequently, these autoantibodies might cause damage through a T-cell mediated response or by deposition and formation of membrane attack complex in the nodes, paranodes or axons. 2,9 Most commonly, the blood-nerve barrier-exposed areas, such as the terminal nerves and roots, are affected before the intermediate nerves; hence, the non-length dependent, symmetric, proximal and distal weakness in most demyelinating GBS. 5,6 GBS with distal only involvement in the acute setting is common, although after several weeks, these cases eventually develop to the classic presentation of GBS.…”

Section: Discussionmentioning

confidence: 99%

Acute‐onset distal dominant neuropathy after severe acute respiratory syndrome coronavirus 2 vaccination in a male patient with recent dengue infection: A case report

Prado,

Adiao

2023

Clinical & Exp Neuroim

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ObjectiveGuillain–Barré Syndrome (GBS) is an autoimmune degenerative disease commonly presenting with acute progressive sensorimotor paralysis, sometimes associated with dysautonomia, facial diplegia and severe respiratory distress. Gastroenteritis due to Campylobacter jejuni and respiratory infection secondary to Epstein–Barr virus usually precede GBS; however, vaccination or recent dengue infection as temporal causes are rarely reported.Case PresentationHere, we present a 20‐year‐old man, who complained of a 5‐day history of a progressively worsening tingling sensation isolated in the hands and feet, and unilateral Bell's palsy on the left side of his face, which occurred 2 weeks after his severe acute respiratory syndrome coronavirus 2 vaccination and 6 weeks from his recent hospitalization from Dengue fever. Except for the left complete unilateral facial paralysis, weakness in the intrinsic hands and feet muscles, and sensory ataxia, the rest of his physical examination was unremarkable. On work‐up, the findings of albuminocytological dissociation and distal sensorimotor demyelinating polyneuropathy in the nerve conduction study supported the diagnosis of GBS.ConclusionThe enhanced immune response from a recent dengue infection and severe acute respiratory syndrome coronavirus 2 vaccination might increase the risk of GBS. The predominantly distal GBS phenotype has rarely been reported in the literature, adding to the peculiarity of this case.

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“…As the latter affects axons, it is also associated with worse prognosis. 4,5 Here we present a case of MMN with severe secondary axonal loss which we hypothesized to be secondary to the concomitant presence of anti-GM1 IgG antibody.…”

Section: Introductionmentioning

confidence: 98%

Mixed IgG and IgM anti-GM1 ganglioside antibody positive multifocal motor neuropathy with severe secondary axonal loss in a Filipino female

Prado¹,

Adiao²

2022

NeuroAsia

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Approximately 40% of patients with multifocal motor neuropathy had anti-GM1 IgM antibodies, while only 1 out of 88 patients had anti-GM1 IgG antibodies. Unlike its predominantly demyelinating IgM counterpart, the anti-GM1 IgG antibody is often seen in the axonal variant of Guillain Barre syndrome. As it affects axons, it is also associated with worse prognosis. We report here a 58-year-old woman who was admitted for 3 months history of progressive asymmetric weakness, initially involving the right-hand extensors, eventually affecting the contralateral side and the lower extremities. The electrodiagnostic examination revealed multifocal pure motor demyelinating neuropathy with severe axonal loss. On nerve ultrasound, the axons were small in non-compressive areas. The extremely elevated anti-GM1 IgM titer (1:51,200, nv<1:800) was consistent with the diagnosis of MMN. Her anti-GM1 IgG antibodies (1: 12,800, nv<1:800) was also elevated. In conclusion, the presence of concomitant anti-GM IgG and anti-GM1 IgM may lead to an MMN with more severe axonal loss.

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Anti-GM1 IgM antibody positive axonal variant of Guillain-Barre-syndrome in a pediatric patient with dengue fever

Cited by 8 publications

References 10 publications

Facial Diplegia as the Sole Manifestation of Post-Vaccination Guillain-Barre Syndrome: A Case Report and Literature Review

Facial Diplegia as the Sole Manifestation of Post-Vaccination Guillain-Barre Syndrome: A Case Report and Literature Review

Acute‐onset distal dominant neuropathy after severe acute respiratory syndrome coronavirus 2 vaccination in a male patient with recent dengue infection: A case report

Mixed IgG and IgM anti-GM1 ganglioside antibody positive multifocal motor neuropathy with severe secondary axonal loss in a Filipino female

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