Guillain–Barré Syndrome During a Relapse of Ulcerative Colitis: A Case Report

Abstract

To the Editor: A 59-year-old male patient was admitted to the hospital for bloody diarrhea and fever. He had a 5-year history of ulcerative colitis (UC) but he was in remission during the last 2 years, being treated with 5-aminosalicylate (5-ASA). Clinical examination demonstrated a well-nourished patient with a normal abdomen. He had mild iron deficiency anemia, the erythrocyte sedimentation rate (ESR) was normal, but C-reactive protein (CRP) was raised to 15.2 mg/L. His biochemical profile was within normal limits except for a slight decrease of the albumins. An abdominal ultrasound showed a slightly enlarged liver with mild steatosis and the presence of sludge in the gallbladder. Chest and abdominal x-ray were normal. Tumor markers (CEA, AFP, CA19-9, CA125, PSA) and thyroid hormones were within normal limits. Stool specimens did not reveal any ova or parasite and stool cultures including Clostridium difficile testing were negative. A colonoscopy showed a typical flare-up of UC with a moderately active chronic UC on histology. He was treated with intravenous (IV) prednisolone 25 mg twice daily and 5-ASA 1000 mg 3 times daily and as soon as clinical improvement was achieved he was discharged. Three days later he was readmitted with lower extremity weakness. On neurological examination the patient was fully consciousness. He had no deficit from cranial nerves. No speech or articulation disorders were detected. We observed neither meningial sign nor jaw reflex. There was a mild to moderate decrease in proximal muscle strength with normal tone. Superficial, vibration, and deep sensory modalities were apparently normal. Deep tendon reflexes of upper and lower extremities were reduced bilaterally. The muscle weakness of the lower extremities was more profound proximally than distally. A moderate impairment of deep sensation was observed, while superficial sensation was normal. There was a flexor plantar response. He was unable to stand or walk without aid. Therefore, he underwent neurophysiological and electromyographical studies. Electromyogram did not show any evidence of acute or chronic denervation in several muscles. However, electroneurogram (ENG) demonstrated a motor-sensory symmetrical demyelinating peripheral polyneuropathy. Cerebrospinal fluid was clear and colorless. Examination showed normal glucose up to 52 mg/dL and pathologically increased albumin up to 905 mg/L. As far as cells were concerned, 2/mm 3 lymphocytes were