Guillain-Barré syndrome in a patient with diabetes mellitus

Abstract

Introduction: Guillain-Barre syndrome (GBS) is a disorder of peripheral nervous system characterized by progressive, symmetrical, ascending paralysis. It is caused by inflammation and demyelination of peripheral nerves and roots of spinal nerves. Common features include absent muscle reflexes and loss of sensation. The aim of this case report is to delineate it from diabetic neuropathy on the basis of symptomatology, and to diagnose it earlier as it can lead to respiratory failure and cardiac arrhythmias in severe cases. Case presentation: A 40 years old female known case of diabetes mellitus for 4 years and hypertension for 2 years presented with paresthesias of both lower limbs which was progressive along with bilateral leg weakness and difficulty in walking without support and standing up from sitting position. Later, she also developed bilateral upper limb paresthesias and weakness. Two months before developing neurological symptoms, she had an episode of fever which lasted for about 7 days without associated symptoms of either respiratory or gastrointestinal tract. Considering her symptoms, GBS was suspected and multiple investigations were performed including lumbar puncture, ECG and NCV, all of which suggested GBS instead of diabetic neuropathy. Hence, sessions of plasmapheresis were started which improved her symptoms and she was discharged after 5 cycles of plasmapheresis as she had no complains of autonomic dysfunction or paralysis of any part of her body. Conclusion: Peripheral neuropathy in a diabetic patient is not always due to diabetes mellitus so other conditions should be considered as well. In such circumstances, specific investigations are required to make an accurate diagnosis.