Guillain–Barre Syndrome: A Rare Presentation of Borderline Tuberculoid Leprosy with Type 1 Lepra Reaction

Abstract

Guillain–Barre syndrome (GBS) is an autoimmune polyradiculoneuropathy usually preceded by respiratory tract or gastrointestinal infection. The pathogenesis in GBS is based on molecular mimicry mechanism. Hansen's disease is common in India and is the most common infectious cause of neuropathy. We describe a 42-year-old man who was being treated for borderline tuberculoid leprosy and developed Type 1 lepra reaction followed by GBS and responded to plasmapheresis. Lepra reaction may lead to exposure of neural antigens, resulting in autoimmune mechanism and demyelination of peripheral nerves.

Neurological Complications of Leprosy

“…59 Rarer neurological manifestations of leprosy include Guillain-Barré syndrome, with the hypothesis that a leprosy reaction may have caused exposure of neural antigens, resulting in autoimmune molecular mimicry with downstream effects of demyelination. 60 The characteristics of neuropathic pain in leprosy are overall similar to those for other etiologies of neuropathy in terms of severity and quality (e.g., burning, pressure, stabbing, pins and needles), although there is some heterogeneity among afflicted patients. 61 A recent small study based in Nepal evaluated 85 patients who had completed MDT, administering questionnaires that evaluated pain severity, impact on daily activities, and mental well-being.…”

Guillain-Barré syndrome following a Type 2 leprosy reaction: A case report

“…Despite this, there are very few reports of the association between GBS and leprosy, whether in the context of a LR or not. [6][7][8][9][10] In conclusion, although leprosy is a chronic infectious disease, it can also be considered an immunological disease, drawing attention to the importance of the differential diagnosis of other neuropathies associated with leprosy and the importance of knowing this rare association to avoid treatment delays and improve patient care in endemic countries.…”

Chronic inflammatory demyelinating polyneuropathy and Type 1 lepra reaction: a rare association

“…9 CIDP is reported in association with other autoimmune diseases like diabetes mellitus and Sjogren's syndrome, neoplastic conditions including melanoma and lymphoma, and infections due to human immuno-deficiency virus and hepatitis C virus. 9 While there are occasional reports of Guillain Barre syndrome as a manifestation of T1R/T2R, 10,11 CIDP in lepra reaction is rare. Andrade et al reported a patient who developed CIDP 12 years after the completion of treatment for mid borderline leprosy.…”