Worsening Guillain-Barré syndrome: harbinger of IRIS in HIV?

Abstract

We report an HIV patient aged 38 years with acute inflammatory demyelinating polyradiculoneuropathy subtype of Guillain-Barré syndrome (GBS) as the only manifestation of seroconversion and worsening of GBS being the harbinger of immune reconstitution inflammatory syndrome (IRIS). To date, only 5 cases of GBS during IRIS are reported. They manifested either during the third week or later after starting highly active antiretroviral therapy (HAART). Our patient witnessed worsening weakness by fifth day after starting HAART, even before the occurrence of pneumonia, cautioning one of the impending serious complications of IRIS and helped us initiate steroids at an early date.

Guillain-Barré syndrome spectrum as manifestation of HIV-related immune reconstitution inflammatory syndrome: case report and literature review

“…In contrast, HIV-related GBS has been classically reported as an early manifestation of HIV infection. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 In this scenario, the occurrence of GBS in HIV is thought to be due to an autoimmune response against myelin sheath due to dysregulation triggered by the primary infection. This potential mechanism also can explain IRIS-related GBS.…”

Immune Reconstitution Inflammatory Syndrome and Hodgkin’s Lymphoma

“…For example, these include pulmonary and extrapulmonary forms of tuberculosis, including atypical nontuberculous mycobacterioses: paratuberculosis, leprosy, fungal infections, parasitosis, contagious mollusks, cryptococcal infection, toxoplasmosis, shingles, leishmaniasis, and exacerbation of syphilis with a return of the initial clinical picture [9][10][11][12][13][14][15][16][17][18][19]. In addition, Guillain-Barré syndrome has been described in patients with HIV infection on HAART [20]. A. Weetman reports thyroiditis occurring 15 months after starting HAART [21].…”