Concurrency of Guillain-Barre syndrome and acute transverse myelitis: a case report and review of literature

Abstract

Guillain-Barré syndrome and acute transverse myelitis manifest as demyelinating diseases of the peripheral and central nervous system. Concurrency of these two disorders is rarely documented in literature. A 4-year-old girl presenting with cough, fever, and an impaired walking ability was admitted to hospital. She had no previous complaints in her medical history. A physical examination revealed lack of muscle strength of the lower extremities and deep tendon reflexes. MRI could not be carried out due to technical problems; therefore, both Guillain-Barré syndrome and acute transverse myelitis were considered for the diagnosis. Intravenous immunoglobulin treatment was started as first line therapy. Because this treatment did not relieve the patient's symptoms, spinal MRI was carried out on the fourth day of admission and demyelinating areas were identified. Based on the new findings, the patient was diagnosed with acute transverse myelitis, and high dose intravenous methylprednisolone therapy was started. Electromyography findings were consistent with acute polyneuropathy affecting both motor and sensory fibers. Therefore, the patient was diagnosed with concurrency of Guillain-Barré syndrome and acute transverse myelitis. Interestingly, while concurrency of these 2 disorders is rare, this association has been demonstrated in various recent publications. Progress in diagnostic tests (magnetic resonance imaging and electrophysiological examination studies) has enabled clinicians to establish the right diagnosis. The possibility of concurrent Guillain-Barré syndrome and acute transverse myelitis should be considered if recovery takes longer than anticipated.

A Rare Case of Acute Transverse Myelitis (ATM) and Acute Motor and Sensory Axonal Neuropathy (AMSAN) Overlap

“…Corticosteroid therapy and plasmapheresis are effective for ATM [12]. The first-line therapy for GBS is intravenous immunoglobulins (IVIG) or plasmapheresis while corticosteroids alone have not proven to be beneficial in the management of GBS and may worsen the weakness [5]. If patients of ATM do not show improvement with initial corticosteroid therapy, the next treatment options are plasmapheresis or IVIG [13].…”

“…Twenty three cases of overlap syndrome reported so far [4]. These cases were mostly preceded by gastrointestinal infections such as Campylobacter jejuni while other cases were associated with Zika virus, Mycoplasma pneumoniae, Legionella pneumophila, Bartonella henselae, Influenza virus, and Paramyxovirus [5][6][7][8][9][10]. Majority of them were reported in the pediatric population and were commonly associated with acute motor axonal neuropathy [11].…”

A possible Guillain-Barré syndrome/transverse myelitis overlap syndrome after recent COVID-19

“…Based on a review of the literature, the majority of reported cases of GBS/TM overlap syndrome have been attributed to infections such as acute viral illness, influenza, Mycoplasma , Legionella , Bartonella and Zika virus 8 11 12. Two previous cases of overlap syndrome after SARS-CoV-2 infection have been reported: one was a paediatric case13 and the other was in a 40-year-old man 14.…”

Acute Polyradiculomyelitis With Spinal Cord Gray Matter Lesions: A Report of Two Cases

“…Finally, despite early immunomodulatory treatment, severe motor impairment and bladder dysfunction persisted even months after symptom onset. In the few reported cases of concomitant myelopolyradiculitis (22)(23)(24), long-term clinical outcomes varied, although pure motor variants seemed to be associated with a poorer prognosis (25).…”