Abstract
The pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome (GBS) is very rare. It is characterized by weakness of the upper extremities associated with bulbar symptoms and facial diplegia. Documented cases were post-infectious, a post-vaccination occurrence has not been documented in the available literature. Even rarer is the occurrence of any variant of GBS following the mumps measles rubella (MMR) vaccine. The neurophysiological hallmark of PCB variant of GBS is a combination of myelinopathy and axonopathy, hence, its consideration as a subtype of the acute motor axonal neuropathy (AMAN) variant. It should be suspected in any case of acute-onset flaccid symmetrical weakness of the upper extremities, as early diagnosis and treatment are key to preventing fatal bulbar weakness. Here we report a case of a middle-aged man, who presented with features of PCB a fortnight after being vaccinated for MMR.
Highlights
Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculopathy that is characterized by an acute-onset symmetrical flaccid muscle weakness with decreased or absent deep tendon reflexes
We report a case of PCB variant of GBS in a native African following mumps measles rubella (MMR) vaccination
Patients with the PCB variant of GBS typically present with rapidly progressive oropharyngeal and cervicobrachial weakness associated with areflexia in the upper limbs and the presence of monospecific IgG anti-GT1a antibodies in the serum is typical [4]
Summary
Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculopathy that is characterized by an acute-onset symmetrical flaccid muscle weakness with decreased or absent deep tendon reflexes. Pharyngeal-cervical-brachial (PCB) variant of GBS is a localized variant that presents with facial palsy, dysarthria, or dysphagia in addition to the weakness of the upper extremity and areflexia of the upper limbs [1]. A 55-year-old man presented with a three-day history of weakness of both upper extremities, which was noticed initially as difficulty in handling cutlery, which progressed to difficulty with lifting both upper limbs. He complained of a worsening moderate to severe pain around the neck and shoulders.
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