Systemic lupus erythematosus presenting as Guillain‒Barre syndrome

Abstract

A 37-year-old male patient presented with acute symmetrical ascending areflexic flaccid quadriparesis progressive in nature for the past 6 days before admission preceded by tingling sensation in both hands and feet with the right-sided lower motor type of facial nerve palsy for 2 days. Clinically, this was consistent with Guillain–Barre (GB) syndrome and was given intravenous immunoglobulin (IVIG). Cerebrospinal fluid study and nerve conduction study also supported the clinical diagnosis of GB syndrome. He developed Type 2 respiratory failure on the 4th day of admission for which he was intubated. After successful extubation, his weakness even worsened markedly despite IVIG therapy and was subjected to plasmapheresis following which the weakness improved remarkably. On further investigation for the associated fever, arthralgia, pallor, nephritis, antinuclear antibody (3+ coarse speckled pattern), anti-smith antibody, and anti-dsDNA antibody positivity were detected with low serum complement levels, and renal biopsy revealing class III lupus nephritis. He was put on oral corticosteroids and cyclophosphamide which resulted in further clinical improvement. The initial presentation of GB syndrome of systemic lupus erythematosus is uncommon and makes this case interesting.