Guillain–Barré syndrome after allogeneic bone marrow transplantation: Case report and literature review

Abstract

A 50-year-old man with acute myelogenous leukemia underwent allogeneic bone-marrow transplantation (BMT). He presented with severe diarrhoea 86 days post BMT and was diagnosed with graft-versus-host disease (GVHD) based on skin and rectal biopsies. He complained of numbness and weakness in the distal extremities at 114 days after BMT. His symptoms rapidly deteriorated and he required mechanical ventilation for respiratory failure. His clinical course and the findings of a nerve conduction study fulfilled the criteria for diagnosis of Guillain–Barré syndrome (GBS). Sural nerve biopsy revealed active demyelination and infiltration of macrophages and CD8+ T-cells. After three cycles of intravenous immunoglobulin therapy, his symptoms gradually improved, and he could eventually walk unassisted. Although GBS has been known to develop after allogeneic BMT, the pathogenesis remains unclear, and specific treatment regimens have not been well established. Here, we report a case of GBS, caused by an immune-mediated mechanism related to GVHD, which was successfully treated using intravenous immunoglobulin therapy.

Guillain-Barre syndrome: a typical paraneoplastic syndrome in a kidney transplant recipient with allograft renal cell carcinoma: a case report and review of the literature

“…Most cases of GBS have been reported in bone marrow transplant recipients and are associated with graft versus host disease (GvHD) [19]. In recipients of solid organ transplants, mainly the heart, liver and kidney, GBS usually appears within 1 year after transplantation and is mainly related to CMV infection [2].…”

Guillain-Barre syndrome observed with adoptive transfer of lymphocytes genetically engineered with an NY-ESO-1 reactive T-cell receptor

“…Of note, GBS/AIDP has been noted as a rare complication of allogenic bone-marrow transplantation (BMT), which can develop 2 days to 15 months after BMT. The pathogenesis is unclear, with proposed mechanisms including infections, drug toxicity, and graft-versus host disease [14, 15]. Another possible etiology of GBS/AIDP includes immune reconstitution inflammatory syndrome (IRIS), as seen with HIV patients quickly after starting therapy or stem cell transplant patients when immunosuppression is reduced [16].…”

Immunosuppression-related neurological disorders in kidney transplantation

“…CMV is the most common viral cause of GBS, and it has been associated with most cases occurring in solid organ recipients, supporting the hypothesis that in these patients viral infections can act as relevant triggers for acute nerve inflammation [71]. GBS has been observed in numerous recipients of bone marrow transplant (BMT), particularly in those undergoing allogeneic BMT [72], but it is rarely seen after solid organ transplantation [73], although these patients are more susceptible to opportunistic infections as a result of immune suppression.…”