Abstract
Vector borne diseases have been associated with a number of autoimmune diseases. In this case we report a 73 year old woman initially diagnosed with lyme disease who subsequently developed guillain-barre syndrome (GBS). Her relevant clinical presentation included protean symptoms of numbness and progressive weakness in her legs for three weeks prior to consultation by the neurology service. A lyme ELISA and confirmatory Western Blot testing were unequivocally positive. A clinical diagnosis of CNS lyme disease was made. Additional clinical evaluation included: electrophysiological testing, which demonstrated significant polyneuropathy consistent with demyelinating pathology. A lumbar puncture with cerebral spinal fluid analysis revealed a non-reactive VDRL, negative lyme DNA PCR, positive lyme IgG antibody and an elevated protein-elevated albumin with normal white count. Upon further clinical deliberation this constellation of signs and symptoms was determined to be more consistent with a diagnosis of GBS rather than CNS lyme disease. Initiation of medical therapy included IVIG (intravenous immunoglobulin) and parenteral ceftriaxone. This case may report an additional vector of disease in patients presenting with clinical signs and symptoms of GBS.
Highlights
Guillain-barre syndrome (GBS) is an acute immune-mediated polyneuropathy that usually presents with progressive ascending weakness [1,2]
Vector borne diseases have been associated with a number of autoimmune diseases. In this case we report a 73 year old woman initially diagnosed with lyme disease who subsequently developed guillain-barre syndrome (GBS)
Due to the rare nature of GBS, the difficulty in making an early diagnosis and challenges associated with appropriate medical management in the early course of disease all may portend a poor prognosis for the patient
Summary
Guillain-barre syndrome (GBS) is an acute immune-mediated polyneuropathy that usually presents with progressive ascending weakness [1,2]. Vital signs revealed labile blood pressure readings ranging from 128/102 mmHg to 178/74 mmHg. On hospital day five, day 4 of IVIG therapy, the patient reported a significant level of pain and had motor strength grading of 1/5 in both legs. Day 4 of IVIG therapy, the patient reported a significant level of pain and had motor strength grading of 1/5 in both legs She was able to move her arms but had numbness up to her face. Day five of IVIG therapy, the patient had better pain management and was starting to regain function back in her lower extremities She was able to dorsiflex and plantarflex her ankle and said the numbness in her face was down to below her neck. The patient was discharged to an inpatient rehabilitation center for ongoing rehabilitation
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