Guillain-Barre-Strohl Syndrome Unraveled as Paraneoplastic Syndrome of B-cell Acute Lymphoblastic Leukemia in a Patient with Preceding Common Variable Immunodeficiency Syndrome with Evans Syndrome

Abstract

A 26-year-old man with a history of common variable immunodeficiency and Evans syndrome (immunthrombocytopenia and immunhemolytic anemia) with sarcoid like lesions and lymph node enlargements in the previous history is described. The patient presented with symptoms resembling Guillain-Barre-Strohl as paraneoplastic syndrome just before the diagnosis of acute lymphoblastic leukemia of the L3 type. The patient was treated according to the B-ALL protocol of the German ALL study group and achieved a complete response after six cycles of chemotherapy together with a resolution of all neurologic symptoms.

Neurologic Complications of Common Variable Immunodeficiency

“…In general, however, the benefit of higher or more frequent dosing of IgG for viral illnesses associated with CVID is not well investigated. Multiple other factors, such as environmental (43) Adenovirus meningoencephalitis (2) [25] Bacterial meningitis (22) [1,[26][27][28][29] BKV encephalitis and optic neuritis (1) [30] CMV encephalomyelitis (1) [31] Echovirus meningoencephalitis (1) [25] Histoplasmosis (1) [28] HSV encephalitis (3) [9] Mumps encephalitis (1) Poliovirus (1) [32] Progressive Multifocal Leukoencephalopathy (6) [3][4][5][6][7][8] Toxoplasma encephalitis (2) [33,34] Varicella angiitis (1) [35] Varicella zoster encephalitis (1) [1] West Nile meningitis (1) [36] Autoimmune/Inflammatory (13) optic neuritis (1) [37] myelitis (4) [10,11,38,39] limbic encephalitis (1) [12] Guillian Barre Syndrome (1) [40] granulomatous mass (4) [41][42][43][44]45] chronic inflammatory demyelinating polyneuropathy (1) [39] acute disseminated encephalomyelitis (2) [14,46] Unknown etiology (10) encephalopathy (4...…”

Miller-Fisher syndrome associated with chronic lymphocytic leukemia

“…[4] Although the association of acute GBS with systemic cancer and hematological malignancies including leukemia has been reported, MFS presenting as a clinical manifestation of tumors is rare. [5,6] Recently, a case of MFS has been reported in the context of Hodgkin's disease. [7] We describe a CLL patient with MFS who responded to therapy with plasmapheresis.…”