Guillain–Barré Syndrome in a patient with systemic lupus erythematosus with underlying pituitary carcinoid: A rare presentation

Abstract

Background: Guillain-Barré syndrome (GBS) is a rare neuropsychiatric symptom of systemic lupus erythematosus (SLE). GBS in individuals with SLE has distinct features than those without SLE. There is much heterogeneity in the treatment and clinical outcome. Even though GI carcinoids have been related with autoimmune illnesses, extra-gastrointestinal carcinoid coexisting with SLE has been documented only once, and coexistent GBS and SLE with pituitary carcinoid have never been reported previously to the best of our knowledge. Greater knowledge of how inflammation causes cytological alterations that contribute to the formation of a carcinoid might help explore newer pathological mechanisms and therapies. Objectives: We report a middle-aged female who presented with sudden onset of weakness in all four limbs, long-standing history of arthralgia, flushing, dizziness, and a malar rash. Materials and methods: The initial evaluation led to the diagnosis of GBS and SLE, for which the patient was treated. Further workup of patient revealed the presence of a carcinoid tumor in the pituitary. Results: Patient was successfully treated with plasmapheresis, steroids, and injection octreotide. Conclusion: In patients with SLE, neuropsychiatric illness may have a plethora of presentation including GBS. Recognizing such rare presentations and evaluating the possibility of a carcinoid tumor in presence of symptoms like a long-standing history of intermittent palpitation, dizziness, profuse sweating, and flushing, should alert the physician of an underlying carcinoid tumor, which could prove detrimental if left untreated.