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Soufi GJ, Hekmatnia A, Hekmatnia F, Zarei AP, Shafieyoon S, Azizollahi S, Riahi F. GBS as unusual presentation of neurobrucellosis: A rare case report. Radiol Case Rep 2024; 19:2125-2129. [PMID: 38645541 PMCID: PMC11026928 DOI: 10.1016/j.radcr.2024.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 04/23/2024] Open
Abstract
Brucellosis is a zoonotic disease caused by small intracellular aerobic Gram-negative bacilli. The literature has frequently documented instances of the gastrointestinal, hepatobiliary, and skeletal systems being involved. In 3%-5% of brucellosis patients, neurobrucellosis has been identified. Guillain-Barré syndrome (GBS) is a disorder of the peripheral nervous system. Acute peripheral neuropathy mimicking GBS caused by brucellosis is rarely reported. Our case is of a 34-year-old male presenting with a 3-week history of weakness in the upper limbs. There was a clear history of milk product consumption preceding the onset of symptoms. Examination showed paraesthesia and muscles paralysis. Brucellosis was confirmed via blood test, and GBS was confirmed via imaging and neuroelectrophysiological assessment. The patient was treated with plasma exchange (PLEX) and commenced on rifampicin, doxycycline and gentamicin during their hospitalization. The patient was discharged with a course of rifampicin and doxycycline to complete. In patients with acute paralysis and GBS-like symptoms, Imaging should be done in addition to serological tests for brucellosis.
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Affiliation(s)
| | - Ali Hekmatnia
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Shamim Shafieyoon
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Azizollahi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farshad Riahi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Ayadi S, Hammouga R, Slim Majoul M, Jamoussi H, Zaimi Y, Mensi A, Fredj M, Mouelhi L. Guillain-Barré syndrome in ulcerative colitis and SARS-CoV-2 infection: a case report and literature review. Future Sci OA 2024; 10:FSO913. [PMID: 38817380 PMCID: PMC11137770 DOI: 10.2144/fsoa-2023-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/03/2023] [Indexed: 06/01/2024] Open
Abstract
Aim: Guillain-Barré syndrome (GBS) occurrence is rare during inflammatory bowel disease (IBD) and SARS-CoV-2 infection. Its association with thrombotic vascular events, which are common during these two entities, is extremely rare. Case report: We report an exceptional association of GBS and cerebral venous thrombosis in a 28-year-old woman with active ulcerative colitis and no previous history of SARS-CoV-2 vaccination. Mildly symptomatic SARS-CoV-2 infection was diagnosed during etiological investigations of cerebral venous thrombosis. GBS symptoms began 10 days later with clinical and electrical abnormalities consistent with axonal GBS. Other GBS causes were excluded. Favorable outcomes were noted after intravenous immunoglobulin perfusion with full recovery 12 months later. Conclusion: Greater attention should be focused on IBD patients with SARS-CoV-2 infection regardless of its severity.
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Affiliation(s)
- Shema Ayadi
- Gastroenterology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Rabeb Hammouga
- Gastroenterology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Slim Majoul
- Neurology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hela Jamoussi
- Neurology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Yosra Zaimi
- Gastroenterology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Asma Mensi
- Gastroenterology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Fredj
- Neurology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Leila Mouelhi
- Gastroenterology Department, Charles Nicolle University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Jayasundara JMHD, Samarawickrama VT, Peiris R, Aponso T, Abeynayake D. Concomitant Guillain-Barré Syndrome in a young Sri Lankan male with severe ulcerative colitis. BMC Gastroenterol 2022; 22:411. [PMID: 36064313 PMCID: PMC9444105 DOI: 10.1186/s12876-022-02455-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Guillain–Barré Syndrome is an immune mediated polyneuropathy. Ulcerative Colitis is an immune mediated chronic inflammatory condition mainly of the large intestine. Guillain–Barré Syndrome can present as a rare extraintestinal manifestation of Ulcerative Colitis when in remission or in a relapse. However, the concomitant presentation of Guillain–Barré Syndrome during a relapse of Ulcerative Colitis is very rare and only a few cases are reported to date. Case presentation A 24 year old young male diagnosed of Ulcerative Colitis presented with bloody diarrhea of frequency more than six times a day. He had been in clinical remission even after defaulting treatment for more than a year. He had also noted difficulty in walking prior to admission to the hospital. He was managed as for a severe relapse of Ulcerative Colitis and Guillain–Barré Syndrome. Appropriate management of both the illnesses helped him to recover. Conclusion Immune mediated diseases can have rare coexisting presentations. We report a case of Ulcerative Colitis with concomitant Guillain–Barré Syndrome. It is essential to be open minded and timely, appropriate treatment led to successful management of both the illnesses.
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Affiliation(s)
| | | | | | - Tilan Aponso
- National Hospital of Sri Lanka, Colombo, Sri Lanka
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Li Q, Liu J, Jiang W, Jiang L, Lu M, Xiao L, Li Y, Lan Y, Li Y. A case of brucellosis-induced Guillain–Barre syndrome. BMC Infect Dis 2022; 22:72. [PMID: 35057735 PMCID: PMC8781241 DOI: 10.1186/s12879-021-07025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/30/2021] [Indexed: 12/01/2022] Open
Abstract
Background Guillain–Barre syndrome (GBS) is a rare neurological complication of brucellosis, and neurobrucellosis is the most common, but they have many similarities in clinical manifestations. Many clinicians are accustomed to merely explaining the manifestations of nervous system involvement with neurobrucellosis, but they ignore the possibility of GBS, and this leads to misdiagnosis, untimely treatment, and serious consequences. Case presentation A 55-year-old male patient was admitted to The First Affiliated Hospital of Harbin Medical University for intermittent fever, fatigue, and waist pain more than three months. Brucellosis was diagnosed from the blood test. Although anti-brucella treatment was given at the time of diagnosis, the disease continued to progress. At the time of the cerebrospinal fluid systematic physical examination and the neuroelectrophysiological test, acute motor sensory axonal neuropathy was diagnosed. The patient was given immediately administered immunoglobulin therapy. After three months of systemic treatment, the patient's muscle strength of the distal limbs gradually recovered. The numbness of the limbs eased slowly, and urination function and respiratory function returned to normal. He could sit by himself. Conclusions The possibility of GBS should be closely monitored for when a brucellosis patient shows typical clinical manifestations of progressive muscle weakness, protein-cell separation of the cerebral spinal fluid, and typical demyelinating sensorimotor polyneuropathy.
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Clinical predictors for mechanical ventilation and prognosis in patients with Guillian-Barre syndrome: a 10-year experience. Neurol Sci 2021; 42:5305-5309. [PMID: 33880677 DOI: 10.1007/s10072-021-05251-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is a common cause of flaccid paralysis. Up to a third of cases result in respiratory failure requiring mechanical ventilation. AIM We aim to study the possible predictors of respiratory compromise requiring mechanical ventilation in cases of GBS as well as their clinical outcome in the UAE population. METHODOLOGY A retrospective observational study was conducted between the periods of January 2009 till January 2019 in a tertiary center in Dubai. Cases were grouped according to their need for mechanical ventilation then compared for possible predicting factors. Up to 1-year follow-up was done to assess the clinical outcome. RESULTS Out of the 82 cases that were included in the study, 64 (78%) were males with a mean age at presentation being 37 ± 14.4. Most of the cases presented with disability score of 4 (n= 33, 40.2%), being bed bound or wheelchair bound. Twenty cases (24.4%) required mechanical ventilation at presentation. Axonal type of nerve injury was present in 11 (55%) patients requiring intubation, in contrast to 17 (27.4%) patients not requiring intubation. Cases that required mechanical ventilation were older (P .028). They also had a reduced rate of recovery after 1 month (P .004), and more residual deficit at 6 months (P .003) and 12 months (P <.001). This also translated in a longer duration of hospital stay (<.001). CONCLUSION Older age at presentation is a major predictor for the need of mechanical ventilation in GBS. This need for mechanical ventilation is associated with longer hospital stay as well as reduced rate of recovery up to 1 year after the onset of presentation.
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Tominaga K, Tsuchiya A, Sato H, Kimura A, Oda C, Hosaka K, Kawata Y, Kimura N, Hayashi K, Yokoyama J, Terai S. Co-existent ulcerative colitis and Guillain-Barré syndrome: a case report and literature review. Clin J Gastroenterol 2019; 12:243-246. [PMID: 30778832 DOI: 10.1007/s12328-019-00939-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/15/2019] [Indexed: 12/25/2022]
Abstract
Ulcerative colitis (UC) is a chronic and recurrent inflammatory disease involving the intestine, and Guillain-Barré Syndrome (GBS) is rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. UC and GBS can be caused by immune system abnormalities and can co-exist. To date, there are 7 reported cases of GBS in patients with UC. However, only one patient developed UC after GBS treatment. We report a rare case of UC that appeared after intravenous immunoglobulin therapy for GBS. This case report and literature review will allow accurate and prompt diagnosis of co-existent GBS and UC.
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Affiliation(s)
- Kentaro Tominaga
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Atsunori Tsuchiya
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan.
| | - Hiroki Sato
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Atsushi Kimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Chiyumi Oda
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Kazunori Hosaka
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Yuzo Kawata
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Naruhiro Kimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Kazunao Hayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Junji Yokoyama
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
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