The Development of Guillain-Barre Syndrome (Gbs) in Association with Confirmed Lyme Disease. A Potential Autoimmune Response in Gbs Secondary to Tick-Borne Diseases?

Abstract

Vector borne diseases have been associated with a number of autoimmune diseases. In this case we report a 73 year old woman initially diagnosed with lyme disease who subsequently developed guillain-barre syndrome (GBS). Her relevant clinical presentation included protean symptoms of numbness and progressive weakness in her legs for three weeks prior to consultation by the neurology service. A lyme ELISA and confirmatory Western Blot testing were unequivocally positive. A clinical diagnosis of CNS lyme disease was made. Additional clinical evaluation included: electrophysiological testing, which demonstrated significant polyneuropathy consistent with demyelinating pathology. A lumbar puncture with cerebral spinal fluid analysis revealed a non-reactive VDRL, negative lyme DNA PCR, positive lyme IgG antibody and an elevated protein-elevated albumin with normal white count. Upon further clinical deliberation this constellation of signs and symptoms was determined to be more consistent with a diagnosis of GBS rather than CNS lyme disease. Initiation of medical therapy included IVIG (intravenous immunoglobulin) and parenteral ceftriaxone. This case may report an additional vector of disease in patients presenting with clinical signs and symptoms of GBS.

Polyradiculopathy in lyme disease: A case report

“…Infekcije ili vakcine aktiviraju imuni sistem i nastaje zapaljenska reakcija usmerena na mijelin ili akson. Mijelin, kao sastavni deo ovojnice, sadrži različite gangliozide i glikolipide GM1, GM2, GD1b, koji su slični liposaharidnim antigenima bakterijske/virusne ovojnice ili molekularne strukture vakcina (8).…”

“…Dijagnoza GBS se zasniva na kliničkoj slici, analizi likvora i EMNG nalazu (8,9). Neobičan nalaz kod našeg pacijenta bila je rana denervacija, povišen broj limfocita u likvoru, prisutna glavobolja, radikularni bol i delimičan odgovor na intravenske imunoglobuline koji se nisu uklapali u kliničku sliku GBS (8,9).…”

“…Dijagnoza GBS se zasniva na kliničkoj slici, analizi likvora i EMNG nalazu (8,9). Neobičan nalaz kod našeg pacijenta bila je rana denervacija, povišen broj limfocita u likvoru, prisutna glavobolja, radikularni bol i delimičan odgovor na intravenske imunoglobuline koji se nisu uklapali u kliničku sliku GBS (8,9). Tok bolesti kod našeg pacijenta bio je samoograničavajući, s blagom formom, pa nije došlo do poremećaja vegetativne funkcije i respiratornih komplikacija, ali je svakako lečen u jedinici intenzivne nege.…”

“…Lajmska bolest treba da se razmotri kod svakog pacijenta sa simptomima i znacima GBS sprovođenjem detaljne anamneze i imunološke pretrage onih koji navode ubod krpelja u prethodnim mesecima, gde važnu ulogu ima lekar u primarnoj zdravstvenoj zaštiti (19,20). Neuroborelioza može da oponaša GBS pa je važno u svakom pojedinačnom slučaju zbog preklapanja simptoma postaviti preciznu dijagnozu (8,19,21).…”

Guillain-Barre Syndrome, Neuroborreliosis, or Both

“…Other causes that have been documented include cytomegalovirus, Epstein-Barr virus, human immunodeficiency virus (HIV), and more recently, Zika virus [2]. There have been limited reports of GBS caused by tick-borne pathogens such as Borrelia burgdorferi [3][4][5][6]. The typical presentation of GBS is an acute progression of limb weakness one to two weeks after immune stimulation with a peak in the weakness at about two to four weeks [7].…”