Leprosy with Guillain Barre Syndrome: A New Neurologic Manifestation?

Abstract

A 19-year-old female patient of lepromatous leprosy with Type II reaction, on multidrug therapy and prednisolone, presented with acute onset flaccid quadriparesis. The cerebrospinal fluid examination revealed albumino-cytologic dissociation. Nerve biopsy showed infiltration with lepra bacilli, features of vasculitis, and demyelination. There were no other identifiable precipitating factors for Guillain Barre Syndrome in this patient. Her condition improved without any steroid therapy. This case emphasizes the hypothesis that cell injury caused by Type II reaction can expose neural antigens and incite an autoimmune reaction in the form of Guillain Barre Syndrome.

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.…”

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

“…Lepra reaction may lead to exposure of neural antigens resulting in autoimmune mechanism and demyelination of peripheral nerves. [ 5 6 ] However, GBSs have been described rarely in patients of leprosy even without lepra reaction. [ 7 8 ] It is very important to differentiate lepra reaction-induced neuropathy from GBS as early treatment is required in GBS and also the two conditions required different treatments.…”