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Rajabally YA. Immunoglobulin and Monoclonal Antibody Therapies in Guillain-Barré Syndrome. Neurotherapeutics 2022; 19:885-896. [PMID: 35648286 PMCID: PMC9159039 DOI: 10.1007/s13311-022-01253-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 12/29/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute autoimmune polyradiculoneuropathy affecting 1-2 subjects per 100,000 every year worldwide. It causes, in its classic form, symmetric weakness in the proximal and distal limb muscles with common involvement of the cranial nerves, particularly facial weakness. Respiratory function is compromised in a case in four. Randomised controlled trials have demonstrated the benefit of therapeutic plasma exchange in hastening time to recovery. Intravenous immunoglobulin was subsequently shown to be as efficacious as plasma exchange in adult subjects. In children, few trials have shown the benefit of intravenous immunoglobulin versus supportive care. Pharmacokinetic studies suggested a relationship between increase in immunoglobulin G level post-infusion and outcome, implying administration of larger doses may be beneficial in subjects with poor prognosis. However, a subsequent trial of a second dose of immunoglobulin in such subjects failed to show improved outcome, while demonstrating a higher risk of thromboembolic side-effects. Monoclonal antibody therapy has more recently been investigated for GBS, after multiple studies in animal models, with different agents and variable postulated mechanisms of action. Eculizumab, a humanised monoclonal antibody against the complement protein C5, was tested in in two randomised, double-blind, placebo-controlled phase 2 trials. Neither showed benefit versus immunoglobulins alone on disability level at 4 weeks, although one study importantly suggested possible, clinically highly relevant, late effects on normalising function. A phase 3 trial is in progress. Preliminary results of a placebo-controlled ongoing study of ANX005, a humanised recombinant antibody against C1q inhibiting the complement cascade, have been promising.
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Affiliation(s)
- Yusuf A Rajabally
- Aston Medical School, Aston University, Birmingham, B4 7ET, UK.
- Inflammatory Neuropathy Clinic, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK.
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2
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Peralta Suarez G, Deng DW, Silva R, Tinoco G. Guillain-Barre Syndrome Amid Osteosarcoma Treatment: A Therapeutic Dilemma and Literature Review. Cureus 2021; 13:e12432. [PMID: 33542879 PMCID: PMC7850509 DOI: 10.7759/cureus.12432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Guillain-Barre syndrome (GBS) is a clinical syndrome with multiple variants. GBS is defined as an acute demyelinating polyneuropathy commonly preceded by infection (bacterial or viral), trauma, or inflammatory processes, which triggers an autoimmune response that affects the peripheral nervous system. This case report describes a patient with high-grade osteosarcoma that completed neoadjuvant chemotherapy and underwent surgical resection with no immediate complications. Fourteen days after the surgery, the patient developed an acute inflammatory demyelinating polyradiculopathy consistent with GBS. As the five-year survival without chemotherapy is only around 20%, this challenging clinical scenario raised questions regarding adjuvant chemotherapy's safe completion in this setting.
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Affiliation(s)
| | - David W Deng
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - Raquel Silva
- Physical Medicine and Rehabilitation, OhioHealth, Columbus, USA
| | - Gabriel Tinoco
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, USA
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3
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Kuriyama K, Koyama Y, Tsuto K, Tokuhira N, Nagata H, Muramatsu A, Oshiro M, Hirakawa Y, Iwai T, Uchiyama H. Gastric lymphoma complicated by phlegmonous gastritis and Guillain-Barré syndrome: A case report. Medicine (Baltimore) 2020; 99:e20030. [PMID: 32358382 PMCID: PMC7440357 DOI: 10.1097/md.0000000000020030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Complications such as severe infection may occur during the chemotherapy of malignant lymphoma. Phlegmonous gastritis (PG) is a rare acute bacterial infection associated with high mortality, requiring early diagnosis, and prompt management. In addition, Guillain-Barré syndrome (GBS) occasionally requires early treatment and intensive care management due to the occurrence of severe neuropathy and respiratory failure. PATIENT CONCERNS A 70-year-old male was diagnosed with primary gastric diffuse large B-cell lymphoma (DLBCL) after the detection of several polypoid tumors with ulcers. The patient underwent chemotherapy for DLBCL and exhibited adverse effects (i.e., fever, vomiting, epigastric pain, and neutropenia). Computed tomography indicated widespread thickening in the gastric wall. Furthermore, approximately 2 weeks later, the patient presented with gradual symmetric lower extremity weakness and respiratory failure due to paralysis of the respiratory muscle. DIAGNOSES DLBCL was diagnosed through a gastric tumor biopsy. On the basis of the computed tomography findings, a culture of gastric juice, nerve conduction studies, and clinical symptoms, this case of gastric lymphoma was complicated with PG and GBS. INTERVENTIONS The patient was treated with antimicrobial therapy and administration of granulocyte colony-stimulating factor for PG, and with intravenous immunoglobulin and intensive care management for GBS. OUTCOMES Despite the aggressive progress of the condition, the patient improved without relapse of DLBCL. CONCLUSION PG was regarded as a precedent infection of GBS. In this article, we present the first reported case of gastric lymphoma complicated with PG and GBS.
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Affiliation(s)
| | | | | | - Natsuko Tokuhira
- Department of Anesthesiology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
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Pathak P, Perimbeti S, Ames A, Moskowitz AJ. Guillain Barré syndrome heralding the diagnosis of angioimmunoblastic T-cell lymphoma. Leuk Lymphoma 2019; 60:1835-1838. [PMID: 30648445 DOI: 10.1080/10428194.2018.1553299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Stuthi Perimbeti
- a Mount Sinai St Luke's and Mount Sinai West , New York , NY , United States
| | - Ashley Ames
- b Memorial Sloan Kettering Cancer Center , New York , NY , United States
| | - Alison J Moskowitz
- b Memorial Sloan Kettering Cancer Center , New York , NY , United States
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5
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Restrepo-Jiménez P, Rodríguez Y, González P, Chang C, Gershwin ME, Anaya JM. The immunotherapy of Guillain-Barré syndrome. Expert Opin Biol Ther 2018; 18:619-631. [DOI: 10.1080/14712598.2018.1468885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Paula Restrepo-Jiménez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Yhojan Rodríguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Paulina González
- Neurology Service, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Davis, CA, USA
| | - M. Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Davis, CA, USA
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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6
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Galassi G, Testa F, Bianchi F, Cappelli G, Chiari A. Acute demyelinating neuropathy associated with rituximab treatment in a patient with relapsing nephrotic syndrome. CEN Case Rep 2017. [PMID: 28634834 DOI: 10.1007/s13730-017-0264-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Giuliana Galassi
- Department of Biomedical, Metabolic and Neural Sciences, University Hospitals of Modena and Reggio Emilia, Via Giardini, 1350, 41010, Modena, Italy.
| | - Francesca Testa
- Department of Nephrology, University Hospitals of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Bianchi
- Department of Biomedical, Metabolic and Neural Sciences, University Hospitals of Modena and Reggio Emilia, Via Giardini, 1350, 41010, Modena, Italy
| | - Gianni Cappelli
- Department of Nephrology, University Hospitals of Modena and Reggio Emilia, Modena, Italy
| | - Annalisa Chiari
- Department of Biomedical, Metabolic and Neural Sciences, University Hospitals of Modena and Reggio Emilia, Via Giardini, 1350, 41010, Modena, Italy
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7
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Variant Guillain-Barré Syndrome in a Patient with Non-Hodgkin's Lymphoma. Case Rep Hematol 2015; 2015:979237. [PMID: 26347834 PMCID: PMC4548068 DOI: 10.1155/2015/979237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/05/2015] [Accepted: 08/03/2015] [Indexed: 11/18/2022] Open
Abstract
We report a 72-year-old female patient with diffuse large B cell non-Hodgkin's lymphoma (NHL) with previous treatment with standard chemotherapy presenting as an acute, ascending, sensorimotor polyneuropathy. Nerve conduction studies and lumbar puncture supported a rare, but ominous, axonal variant of Guillain-Barré Syndrome (GBS) known as acute motor and sensory axonal neuropathy (AMSAN), which is distinguished from the more common, acute demyelinating forms of GBS. Previous reports have largely focused on toxicities secondary to chemo- or radiotherapy as a major contributor to the development of acute neuropathies in malignancy. Clinicians should also be mindful of direct neoplastic invasion or, less commonly, paraneoplastic phenomenon, as alternative mechanisms, the latter possibly reflecting immune dysregulation in particularly aggressive lymphomas. At the time of writing, this is the first report in the literature of an axonal variant of GBS in a patient with diffuse large B cell NHL. A discussion regarding common and uncommon neuropathies in haematological malignancies is made, with a brief review of the anecdotal evidence supporting a paraneoplastic association with GBS or its variant forms in the setting of lymphoma.
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8
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Stübgen JP. Lymphoma-associated dysimmune polyneuropathies. J Neurol Sci 2015; 355:25-36. [PMID: 26070654 DOI: 10.1016/j.jns.2015.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/05/2015] [Accepted: 06/01/2015] [Indexed: 12/24/2022]
Abstract
Lymphoma consists of a variety of malignancies of lymphocyte origin. A spectrum of clinical peripheral neuropathy syndromes with different disease mechanisms occurs in about 5% of lymphoma patients. There exists a complex inter-relationship between lymphoproliferative malignancies and autoimmunity. An imbalance in the regulation of the immune system presumably underlies various immune-mediated neuropathies in patients with lymphoma. This article reviews lymphoma and more-or-less well-defined dysimmune neuropathy subgroups that are caused by humoral and/or cell-mediated immune disease mechanisms directed against known or undetermined peripheral nerve antigens.
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Affiliation(s)
- Joerg-Patrick Stübgen
- Department of Neurology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY 10065-4885, USA.
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9
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Honig A, Karussis D. Delayed-onset flaccid paralysis related to west Nile virus reactivation following treatment with rituximab: a case report. BMC Res Notes 2014; 7:852. [PMID: 25427863 PMCID: PMC4289184 DOI: 10.1186/1756-0500-7-852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 11/06/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Neurological manifestations of West Nile virus infection include meningitis, encephalitis and acute flaccid paralysis. Typically, West Nile virus-associated acute flaccid paralysis is characterized by acute and rapidly progressing limb weakness, occurring early in the course of the disease. CASE PRESENTATION We report a patient of Yemenite descent who developed West Nile virus-encephalitis and poliomyelitis two weeks following treatment with rituximab for B cell lymphoma, and delayed encephalitis with ascending demyelinating polyneuropathy 6 months later. Diagnosis of the first episode was based on a high West Nile virus copy number in the blood polymerase chain reaction. During the second episode the patient developed encephalitis and flaccid asymmetric quadriparesis, accompanied by high IgM anti-West Nile virus titers in the blood and cerebrospinal fluid. CONCLUSION The delayed polyneuropathy post-West Nile virus infection and encephalitis/poliomyelitis may be related to reactivation of the virus or to a delayed autoimmune (post-infectious) process, possibly accelerated by the recovering B-cell humoral immunity, 6 months after treatment with rituximab. This case depicts the complexities of the immune responses and their reconstitution following monoclonal antibody treatment and the diversity of neurological syndromes associated with West Nile virus infection.
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Affiliation(s)
| | - Dimitrios Karussis
- Department of Neurology, Laboratory of Neuroimmunology and Agnes Ginges Center for Neurogenetics and Multiple Sclerosis, Hadassah-Hebrew University Hospital, Ein-Karem, Il-91120 Jerusalem, Israel.
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10
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Kiyat Atamer A, Okutur K, Tüzün E, Hasbal B, Boyaciyan A, Krespi Y, Demir G. Guillain-Barre Syndrome in a Patient with Primary Extranodal Intestinal Non-Hodgkin's Lymphoma: Paraneoplastic, Drug Induced or Coincidental? Noro Psikiyatr Ars 2014; 51:288-292. [PMID: 28360641 DOI: 10.4274/npa.y7059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/03/2013] [Indexed: 12/26/2022] Open
Abstract
Neurological involvement is observed in 5%-25% of patients with lymphoma being either the first presentation of the disease or emerging during its course. However, Guillain-Barré syndrome is rarely reported. In this article, we present a case with intestinal lymphoma developing Guillain-Barré syndrome during the course of the disease. A 66-year-old male patient with primary extranodal intestinal lymphoma developed quadriparesis, sensory deficits and autonomic dysfunction while receiving chemotherapy. The findings of clinical, electrophysiological and laboratory examinations were consistent with Guillain-Barré syndrome. Guillain-Barré syndrome can potentially be fatal and mimic chemotherapy-induced neurotoxicity, especially in patients with lymphoma, and therefore, must be considered in the differential diagnosis.
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Affiliation(s)
- Aslı Kiyat Atamer
- İstanbul Bilim University Faculty of Medicine, Department of Neurology, İstanbul, Turkey
| | - Kerem Okutur
- İstanbul Bilim University Faculty of Medicine, Department of Medical Oncology, İstanbul, Turkey
| | - Erdem Tüzün
- İstanbul University İstanbul Faculty of Medicine, Institute of Experimental Medicine, İstanbul, Turkey
| | - Barış Hasbal
- İstanbul Bilim University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Ari Boyaciyan
- Vehbi Koç Foundation American Hospital, Department of Neurology, İstanbul, Turkey
| | - Yakup Krespi
- İstanbul Bilim University Faculty of Medicine, Department of Neurology, İstanbul, Turkey
| | - Gökhan Demir
- İstanbul Bilim University Faculty of Medicine, Department of Medical Oncology, İstanbul, Turkey
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11
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Tzachanis D, Hamdan A, Uhlmann EJ, Joyce RM. Successful treatment of refractory Guillain-Barré syndrome with alemtuzumab in a patient with chronic lymphocytic leukemia. Acta Haematol 2014; 132:240-3. [PMID: 24853856 DOI: 10.1159/000358292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/02/2014] [Indexed: 12/19/2022]
Abstract
This is the case of a 79-year-old man with chronic lymphocytic leukemia who presented with Guillain-Barré syndrome with features overlapping with the Miller Fisher syndrome and Bickerstaff brainstem encephalitis and positive antiganglioside GQ1b antibody about 6 months after treatment with bendamustine and rituximab. His clinical and neurologic condition continued to deteriorate despite sequential treatment with corticosteroids, intravenous immunoglobulin and plasmapheresis, but in the end, he had a complete and durable response to treatment with alemtuzumab.
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MESH Headings
- Aged
- Alemtuzumab
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antigens, CD/immunology
- Antigens, Neoplasm/immunology
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Autoantibodies/blood
- Autoantibodies/immunology
- Autoantigens/immunology
- Bendamustine Hydrochloride
- CD52 Antigen
- Combined Modality Therapy
- Consciousness Disorders/drug therapy
- Consciousness Disorders/etiology
- Consciousness Disorders/therapy
- Gangliosides/immunology
- Glycoproteins/antagonists & inhibitors
- Glycoproteins/immunology
- Guillain-Barre Syndrome/drug therapy
- Guillain-Barre Syndrome/etiology
- Guillain-Barre Syndrome/therapy
- Herpes Zoster/complications
- Herpesvirus 3, Human/physiology
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Methylprednisolone/therapeutic use
- Miller Fisher Syndrome/drug therapy
- Miller Fisher Syndrome/etiology
- Miller Fisher Syndrome/therapy
- Nitrogen Mustard Compounds/administration & dosage
- Nitrogen Mustard Compounds/adverse effects
- Plasmapheresis
- Remission Induction
- Rituximab
- Virus Activation
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12
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Lehmann HC, Hughes RAC, Kieseier BC, Hartung HP. Recent developments and future directions in Guillain-Barré syndrome. J Peripher Nerv Syst 2013; 17 Suppl 3:57-70. [PMID: 23279434 DOI: 10.1111/j.1529-8027.2012.00433.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Guillain-Barré syndrome (GBS) encompasses a spectrum of acquired neuropathic conditions characterized by inflammatory demyelinating or axonal peripheral neuropathy with acute onset. Clinical and experimental studies in the past years have led to substantial progress in epidemiology, pathogenesis of GBS variants, and identification of prognostic factors relevant to treatment. In this review we provide an overview and critical assessment of the most recent developments and future directions in GBS research.
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Affiliation(s)
- Helmar C Lehmann
- Department of Neurology, Heinrich-Heine-University, Medical School, Moorenstrasse 5, Düsseldorf, Germany
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13
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Alvarez-Lario B, Prieto-Tejedo R, Colazo-Burlato M, Macarrón-Vicente J. Severe Guillain–Barré syndrome in a patient receiving anti-TNF therapy. Consequence or coincidence. A case-based review. Clin Rheumatol 2013; 32:1407-12. [DOI: 10.1007/s10067-013-2272-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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14
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Liang JJ, Singh PP, Witzig TE. Recurrent acute inflammatory demyelinating polyradiculoneuropathy following R-CHOP treatment for non-Hodgkin lymphoma. Proc AMIA Symp 2013; 26:156-8. [PMID: 23543974 DOI: 10.1080/08998280.2013.11928942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Acute flaccid paralysis following chemotherapy has a wide differential diagnosis, including drug toxicity, acute inflammatory demyelinating polyradiculoneuropathy (AIDP), and malignant nerve infiltration. We present a case of recurrent acute quadriparesis due to AIDP following chemotherapy for non-Hodgkin lymphoma, which resolved each time following administration of intravenous immunoglobulin. Although many chemotherapeutic agents can cause neurologic side effects, such as peripheral neuropathy, drug toxicity as a cause is a diagnosis of exclusion.
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Affiliation(s)
- Jackson J Liang
- Department of Medicine (Liang) and the Divison of Hematology and Medical Oncology (Singh, Witzig), Mayo Clinic, Rochester, Minnesota
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15
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Machida H, Shinohara T, Hatakeyama N, Okano Y, Nakano M, Tobiume M, Naruse K, Iwahara Y, Ogushi F. CD5-positive diffuse large B cell lymphoma infiltrating the central nervous system presenting Guillain-Barré-like syndrome after chemotherapy. J Clin Exp Hematop 2012; 52:199-204. [PMID: 23269080 DOI: 10.3960/jslrt.52.199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
An 83-year-old woman was admitted to our hospital with abdominal pain. Examination revealed mediastinal lymphoadenopathy, hepatosplenomegaly, and infiltration of abnormal cells into the bone marrow with hemophagocytosis, and CD5-positive diffuse large B cell lymphoma was diagnosed. Chemotherapy was administered and progressive weakness of the limbs, resembling a Guillain-Barré-like syndrome, subsequently appeared. Cerebrospinal fluid examination indicated lymphoma cell infiltration. Although immune globulin and steroid therapies were not effective, intrathecal injection of methotrexate, predonisolone, and cytarabine improved these symptoms. Subsequent to chemotherapy, cell surface antigen changes were observed in the cerebrospinal fluid relative to those in bone marrow.
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Affiliation(s)
- Hisanori Machida
- Division of Pulmonary Medicine, National Hospital Organization National Kochi Hospital, Kochi, Japan.
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16
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Guillain-Barré syndrome as first presentation of non-Hodgkin lymphoma. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2011.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Polo-Romero FJ, Sánchez-Beteta P, Perona-Buendía P, Pérez-García AM. Guillain-Barré syndrome as first presentation of non-Hodgkin lymphoma. Neurologia 2012; 27:511-3. [PMID: 22217525 DOI: 10.1016/j.nrl.2011.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 10/17/2011] [Accepted: 10/27/2011] [Indexed: 02/02/2023] Open
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18
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Marino D, Farina P, Jirillo A, De Franchis G, Simonetto M, Aversa SML. Neurological syndrome after R-CHOP chemotherapy for a non-Hodgkin lymphoma: what is the diagnosis? Int J Hematol 2011; 94:461-2. [PMID: 21993875 DOI: 10.1007/s12185-011-0942-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 09/16/2011] [Accepted: 09/20/2011] [Indexed: 11/26/2022]
Abstract
A 63-year-old man was admitted to our Oncology department for management of a follicular non-Hodgkin lymphoma, stage IV A FLIPI 5. The patient entered chemotherapy following the R-CHOP schedule, and a PET scan after three cycles showed partial remission. One week later he was admitted to our hospital after developing serious pain in his left arm resulting in an impaired function, right facial hemiplegia, and ophthalmoplegia. Neuroimaging studies and laboratory features were negative. Given his symptoms, we suspected Miller Fisher syndrome and the patient was administered high dose immunoglobulin, but showed no improvement. Finally, chemotherapy with methotrexate 3 g/mq was initiated, but his condition progressively worsened and the patient died 2 months later. We suggest that any patient with neurological symptoms who has received rituximab should undergo PCR analysis for all neurotropic viruses together with neurophysiological and neuroimaging studies.
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Affiliation(s)
- Dario Marino
- Department of Oncology, Istituto Oncologico Veneto, IRCCS, Via Gattamelata 64, 35100 Padova, Italy.
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19
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Rezania K, Soliven B, Baron J, Lin H, Penumalli V, van Besien K. Myasthenia gravis, an autoimmune manifestation of lymphoma and lymphoproliferative disorders: case reports and review of literature. Leuk Lymphoma 2011; 53:371-80. [PMID: 21864038 DOI: 10.3109/10428194.2011.615426] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kourosh Rezania
- Department of Neurology, University of Chicago Medical Center, Chicago, IL 60637, USA.
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20
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Hartung HP, Lehmann HC, Kieseier BC, Hughes RAC. Novel treatment for immune neuropathies on the horizon. J Peripher Nerv Syst 2011; 16:75-83. [DOI: 10.1111/j.1529-8027.2011.00334.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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21
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Colantuoni M, Matano E, Alfieri S, De Placido S, Carlomagno C. Guillain-Barre Syndrome Associated with Gastric Cancer: Paraneoplastic Syndrome or Immunological Disorder? World J Oncol 2011; 1:247-249. [PMID: 29147216 PMCID: PMC5649751 DOI: 10.4021/wjon259w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2010] [Indexed: 01/12/2023] Open
Abstract
Guillain-Barre syndrome is a rare clinical entity classified as an ascending muscle paralysis led by autonomic nervous dysfunction due to autoimmune damage of peripheral nerves. Paraneoplastic Guillain-Barre syndrome has been described in association with some kinds of tumors (B-cell Lymphoma and small cell lung cancer). We describe the case of a 74-year-old woman affected by gastric adenocarcinoma, treated with surgery and adjuvant chemotherapy, who developed simultaneously skin cancer relapse and severe Guillain-Barre syndrome. Although the timing of clinical presentation suggests a paraneoplastic origin, other interesting features were present in this patient such as familial and personal anamnesis for autoimmune disease, HCV infection, and neurotoxic chemotherapy. According to literature, we investigated different pathogenetic hypothesis. According to the poorness of data, further investigations are necessary to establish a relationship between Guillain-Barre syndrome and gastric cancer.
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Affiliation(s)
- Maria Colantuoni
- Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, Naples, Italy
| | - Elide Matano
- Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, Naples, Italy
| | - Salvatore Alfieri
- Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, Naples, Italy
| | - Sabino De Placido
- Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, Naples, Italy
| | - Chiara Carlomagno
- Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, Naples, Italy
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Brunn A, Utermöhlen O, Sánchez-Ruiz M, Montesinos-Rongen M, Blau T, Schlüter D, Deckert M. Dual role of B cells with accelerated onset but reduced disease activity in P0₁₀₆₋₁₂₅-induced experimental autoimmune neuritis of IgH ⁰(/)⁰ mice. Acta Neuropathol 2010; 120:667-81. [PMID: 20640902 DOI: 10.1007/s00401-010-0724-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 07/02/2010] [Accepted: 07/10/2010] [Indexed: 12/22/2022]
Abstract
The role of B cells in autoimmune-mediated diseases of the peripheral nervous system was studied in experimental autoimmune neuritis (EAN) in B cell deficient IgH⁰(/)⁰ C57BL/6J mice having been immunized with P0₁₀₆₋₁₂₅ peptide. Compared to coisogenic IgH(+/+) mice, onset of EAN was accelerated [100% disease incidence at day 9 post immunization (p.i.) vs. day 15 p.i.]. At day 9 p.i., numbers of P0₁₀₆₋₁₂₅-specific interferon (IFN)-γ-producing CD4(+) T cells were increased, while IL-10 mRNA and production were decreased in IgH⁰(/)⁰ mice. Beyond day 9 p.i., declining disease activity and a significant reduction of maximal disease activity were correlated with significantly reduced numbers of IFN-γ-producing CD4(+) T cells in IgH(0/0) mice as compared with IgH(+/+) mice. Correspondingly, neuropathology demonstrated only mild axonal damage, while demyelination and dying back axonopathy with spinal cord motor neuron apoptosis were absent. Thus, depending on the stage of EAN, B cells play a dual, i.e. suppressive and enhancing, role during induction and at height of EAN, respectively. The combined interaction of B cells as well as CD4(+) and CD8(+) T cells is required for the development of EAN.
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Affiliation(s)
- Anna Brunn
- Department of Neuropathology, University Hospital of Cologne, Germany.
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Steiner I, Rosenberg G, Wirguin I. Transient immunosuppression: a bridge between infection and the atypical autoimmunity of Guillain-Barré syndrome? Clin Exp Immunol 2010; 162:32-40. [PMID: 20735441 DOI: 10.1111/j.1365-2249.2010.04223.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute, usually monophasic, disorder of the peripheral nervous system that is assumed to be of immune-mediated pathogenesis. However, several clinical features and experimental findings of GBS are uncharacteristic for an immune-mediated disorder and set this condition apart from other disorders with a putative immune-mediated pathogenesis. These features include, among others, the monophasic nature of GBS, the lack of response to immunosuppressive (unlike immunomodulatory) therapy, the absence of a typical association with immunogenetic background and the inability to establish a valid and relevant animal model. We suggest a comprehensive hypothesis for the pathogenesis of GBS that is based on the assumption that the condition is due to a transient (or occasionally chronic) immune deficiency, as in most cases GBS follows an infection with pathogens known to induce immunosuppression. Such infections may be followed by breakdown of immune tolerance and induction of an immune attack on peripheral nerves. Mounting of the immune-mediated assault might be triggered either by the same infective pathogen or by secondary infection. Clearance of the infection and resumption of a normal immune response and tolerance eventually terminate the immune-mediated damage to the peripheral nerves and enable recovery. This hypothesis assumes that the entire sequence of events that culminates in GBS is due to transient exogenous factors and excludes a significant role for inherent host susceptibility, which explains the monophasic nature of the disorder.
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Affiliation(s)
- I Steiner
- Department of Neurology, Rabin Medical Center, Petah Tiqva, D-Pharm Ltd, Kiryat Weizmann Science Park, Rehovot, Israel.
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Toema B, El-Sweilmeen H, Helmy T. Oculomotor nerve palsy associated with bortezomib in a patient with multiple myeloma: a case report. J Med Case Rep 2010; 4:342. [PMID: 20977708 PMCID: PMC2984468 DOI: 10.1186/1752-1947-4-342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 10/26/2010] [Indexed: 11/30/2022] Open
Abstract
Introduction Bortezomib is a proteasome inhibitor used in the treatment of multiple myeloma. A newly recognized oculomotor nerve palsy related to bortezomib is described. Case presentation A 54-year-old Caucasian woman with immunoglobulin G kappa multiple myeloma on single-agent bortezomib given by intravenous push once weekly developed isolated unilateral partially reversible left sided oculomotor nerve palsy during the first cycle of treatment. All the essential diagnostic tests that were carried out excluded all other possible causes. There was a positive dechallenge-rechallenge test. Management was by withdrawal of bortezomib and empirical dexamethazone. To the best of our knowledge, this is the first report of its kind in the literature. Conclusion This case illustrates the probable association between oculomotor nerve palsy and bortezomib, and generates a hypothesis of whether bortezomib can cross the blood-brain barrier or not.
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Affiliation(s)
- Bassem Toema
- Division of Hematology and Oncology, Internal Medicine Department, Saad Specialist Hospital, Prince Faisal Bin Fahed Street, P,O, Box 30353, AlKhobar, 31952, Saudi Arabia.
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Naveed S, Okoli K, Hollingsworth J, Kasmani R. Guillain-Barré syndrome as a paraneoplastic manifestation of small-cell carcinoma of lung. South Med J 2010; 103:156-8. [PMID: 20175250 DOI: 10.1097/smj.0b013e3181bfd2c0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Guillain-Barré syndrome (GBS) encompasses the variants of acute immune-mediated polyneuropathies usually preceded by an infection. A few case reports have associated GBS to neoplastic diseases. It remains unclear whether these are merely coincidental or represent paraneoplastic phenomena. The clinical features of GBS associated with oncological cases do not appear to differ from post-infectious GBS. We report a 74-year-old man in whom small cell carcinoma of lung (SCLC) was diagnosed during a presentation with GBS. Treatment with chemotherapy for SCLC and intravenous immunoglobulins led to complete neurological recovery and tumor regression.
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Affiliation(s)
- Sajid Naveed
- Department of Internal Medicine, UPMC, McKeesport, PA, USA
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Jaso R, Sierra M, Calleja J, Valero C, Pascual J. Guillain–Barré syndrome after rituximab in a patient with idiopathic thombocytopenic purpura: a causal association? J Neurol 2009; 257:488-9. [DOI: 10.1007/s00415-009-5400-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Revised: 11/10/2009] [Accepted: 11/12/2009] [Indexed: 01/28/2023]
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Ravaglia S, Corso A, Piccolo G, Lozza A, Alfonsi E, Mangiacavalli S, Varettoni M, Zappasodi P, Moglia A, Lazzarino M, Costa A. Immune-mediated neuropathies in myeloma patients treated with bortezomib. Clin Neurophysiol 2008; 119:2507-12. [DOI: 10.1016/j.clinph.2008.08.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 08/14/2008] [Accepted: 08/19/2008] [Indexed: 10/21/2022]
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28
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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