Abstract Details

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Abstract Details

Title A Rare Case Of Guillain-Barre Syndrome Associated with Nontuberculous Mycobacterium Infection

Topic Infectious Disease

Presentation(s) P13 - Poster Session 13 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-016

Objective

To report a rare case of Guillain-Barre Syndrome associated with nontuberculous Mycobacterium infection

Background

Guillain-Barre Syndrome (GBS) is characterized by rapidly evolving ascending weakness, sensory loss, and hyporeflexia or areflexia with cerebrospinal fluid (CSF) evaluation revealing albuminocytologic dissociation. It is commonly associated with an antecedent infection, with molecular mimicry of the organism precipitating an auto-immune reaction resulting in demyelination of the peripheral nerves.

Design/Methods

22-month-old girl, of Peruvian descent with no recent history of travel, presented with leg pain and worsening weakness for 1 week, following a gastrointestinal infection.
On examination, she was noted to be areflexic with symmetric weakness in legs.

Results Her CBC, metabolic panel, erythrocyte sedimentation rate, and C-reactive protein were within the normal range. Her CSF studies showed 0 RBC /cu mm, 5 WBC /cu mm, glucose was 56 mg/dl, and protein was 352 mg/dl. Her other lab tests, including Anti-ganglioside antibodies, Campylobacter jejuni antibodies, and the paraneoplastic panel was negative.
EMG/NCS was notable for generalized demyelinating neuropathy of sensory and motor nerves in upper and lower limbs. She had MRI imaging of Thoracic and Lumbar Spine, which showed diffuse abnormal enhancement of the cauda equina nerve roots. MRI of the thoracic spine also showed an incidental enhancing mediastinal mass. Her PPD testing was positive. Cultures from 2 of the mediastinal mass biopsy specimens revealed a slow, non-cording acid-fast bacillus, with PCR testing of the specimens indicating nontuberculous Mycobaceterium.
She received Intravenous Immunoglobulin for 5 days for GBS with significant improvement in strength.

Conclusions There are only a handful of cases of GBS associated with Mycobacterium infection, with no reported case of nontuberculous Mycobacterium associated GBS. This case shows that in an appropriate clinical context, mycobacterium infection should be considered as a possible associated condition when evaluating patients with Guillain-Barre syndrome.

Authors/Disclosures
Subhendu Rath, MBBS (Virginia Commonwealth University) PRESENTER	Dr. Rath has nothing to disclose.
Francis J. DiMario, Jr., MD (CT Childrens Medical Ctr)	No disclosure on file