Pharyngeal-cervical-brachial variant of Guillain-Barré syndrome with predominant bulbar palsy and anti-GM3 IgG antibodies

A Severe Pharyngeal-Sensory-Ataxic Variant of Guillain-Barré Syndrome With Transient Cardiac Dysfunction and a Positive Anti-sulfatide IgM

Guillain-Barré syndrome (GBS) is a heterogeneous group of acute immune-mediated polyradiculoneuropathy that typically presents with classic axonal or demyelinating sensory-motor type. However, there are variants of GBS with atypical presentation. We report a rare case of severe pharyngeal-sensory-ataxic variant of GBS associated with poor cardiac systolic function, elevated troponin, and positive anti-sulfatide IgM. The sensory symptom atypically started in the hands in an ascending pattern, which progressed to involve the trunk and face and, later, all limbs. It was associated with severe dysphagia, ataxia, and generalized areflexia but with preserved muscle strength in all extremities. Recognizing the atypical pattern of presentation and the ability to perform an accurate clinical localization are the utmost important initial steps in making the diagnosis. The patient showed complete recovery after immunoglobulin therapy.

A 48-Year-Old Man With Excessive Drooling and Descending Paralysis Requiring Mechanical Ventilation

CASE PRESENTATION

A 48-year-old man presented with a chief report of worsening dysphagia for 5 days. Initially, he had difficulty swallowing solids, but it has progressed to difficulty with liquids. There was associated sialorrhea, hypophonia, slurring of speech, hoarseness of voice, cough, and prominent upper extremity weakness. Of note, 2 weeks ago, the patient had an upper respiratory tract infection (including otitis media) that was treated with amoxicillin-clavulanate. His wife and son were also recently sick with an upper respiratory tract infection. His medical history included hypertension managed with amlodipine; he denied any history of TB, recent travel, or canned food ingestion. He denied fevers, stridor, dyspnea, rash, odynophagia, nausea, vomiting, or diarrhea.