ギランバレー症候群に自己免疫性溶血性貧血を併発した一症例

Abstract

A 68-year-old man was admitted to our hospital with the chief complaint of progressive weakness of the limbs.Upon neurological examination, he demonstrated facial palsy, flaccid quadriplegia, and demon-strated no response to all deep tendon reflexes stimulation. Laboratory results showed abnormally elevated levels of anti-ganglioside GM1, asialo-GM1, GD1b, and GM3 antibodies. Stool culture for campylobacter species was negative.A diagnosis of a Guillain-Barre syndrome (GBS) was made and three plasma exchanges were administered. Following the treatment, muscle strength was gradually recovered. Progressive anemia of a mild degree was observed with an increase of unconjugated bilirubin. The direct (DAT) and indirect antiglobulin tests were positive, although the decrease of haptoglobin level was not so pronounced. Testing for Donath-Landsteiner antibody proved negative and cold hemagglutinin test was normal. DAT became negative concomitantly with the recovery from anemia and muscle weakness.The absorption of purified GM3 resulted in remarkably weak reactivity, indicating the affinity of anti-GM3 antibody with the erythrocyte membrane in this patient. Thus, the presence of anti-GM3 antibody, which has common reactivity with peripheral nerve myelin and erythrocyte membrane, may contribute to GBS becoming complicated with hemolytic anemia.