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Corticosteroids can help distinguish between Guillain-Barré syndrome and first attack of chronic inflammatory demyelinating neuropathy: an illustrative case report.
Med Princ Pract. 2008; 17(5):422-4.MP

Abstract

OBJECTIVE

To report a case of acquired demyelinating neuropathy that failed to improve upon treatment with intravenous immunoglobulins and plasmapheresis but responded dramatically to corticosteroids, illustrating the occasional difficulty in distinguishing Guillain-Barré syndrome (GBS) from a first attack of chronic inflammatory demyelinating polyneuropathy (CIDP).

CLINICAL PRESENTATION AND INTERVENTION

A 25-year-old previously healthy man was admitted with a 5-day history of ascending areflexic paralysis of all 4 limbs and diagnosed with GBS. On admission, he was administered intravenous immunoglobulins at a dosage of 400 mg/kg/day for 5 days yet continued to worsen. He became quadriparetic by the second week. As there had been no improvement, he was plasmapheresed with 7 sessions of plasma exchange, 50 ml/kg of plasma at each session, including appropriate replacement fluid. After failing to improve within 8 weeks, he was started on intravenous methylprednisolone and a dramatic improvement was observed by the 5th day. He continued to get better on oral prednisolone, was ambulatory with support 4 weeks later and could walk without support on follow-up.

CONCLUSION

This case illustrates that there is a subset of patients initially diagnosed with GBS who do not respond to immunoglobulins or plasmapheresis but do specifically well on steroids. Hence treatment with prednisolone should not be delayed in selective cases of GBS as it may actually be a first episode of CIDP.

Authors+Show Affiliations

Department of Neurology, Ibn Sina Hospital, Kuwait. drkjalex@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

18685286

Citation

Alexander, K John, et al. "Corticosteroids Can Help Distinguish Between Guillain-Barré Syndrome and First Attack of Chronic Inflammatory Demyelinating Neuropathy: an Illustrative Case Report." Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre, vol. 17, no. 5, 2008, pp. 422-4.
Alexander KJ, Alshubaili AF, Santhamoorthy P, et al. Corticosteroids can help distinguish between Guillain-Barré syndrome and first attack of chronic inflammatory demyelinating neuropathy: an illustrative case report. Med Princ Pract. 2008;17(5):422-4.
Alexander, K. J., Alshubaili, A. F., Santhamoorthy, P., & Sharafuddin, K. M. (2008). Corticosteroids can help distinguish between Guillain-Barré syndrome and first attack of chronic inflammatory demyelinating neuropathy: an illustrative case report. Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre, 17(5), 422-4. https://doi.org/10.1159/000141510
Alexander KJ, et al. Corticosteroids Can Help Distinguish Between Guillain-Barré Syndrome and First Attack of Chronic Inflammatory Demyelinating Neuropathy: an Illustrative Case Report. Med Princ Pract. 2008;17(5):422-4. PubMed PMID: 18685286.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Corticosteroids can help distinguish between Guillain-Barré syndrome and first attack of chronic inflammatory demyelinating neuropathy: an illustrative case report. AU - Alexander,K John, AU - Alshubaili,Asmahan F, AU - Santhamoorthy,P, AU - Sharafuddin,K M, Y1 - 2008/08/06/ PY - 2007/05/02/received PY - 2007/08/12/accepted PY - 2008/8/8/pubmed PY - 2009/1/1/medline PY - 2008/8/8/entrez SP - 422 EP - 4 JF - Medical principles and practice : international journal of the Kuwait University, Health Science Centre JO - Med Princ Pract VL - 17 IS - 5 N2 - OBJECTIVE: To report a case of acquired demyelinating neuropathy that failed to improve upon treatment with intravenous immunoglobulins and plasmapheresis but responded dramatically to corticosteroids, illustrating the occasional difficulty in distinguishing Guillain-Barré syndrome (GBS) from a first attack of chronic inflammatory demyelinating polyneuropathy (CIDP). CLINICAL PRESENTATION AND INTERVENTION: A 25-year-old previously healthy man was admitted with a 5-day history of ascending areflexic paralysis of all 4 limbs and diagnosed with GBS. On admission, he was administered intravenous immunoglobulins at a dosage of 400 mg/kg/day for 5 days yet continued to worsen. He became quadriparetic by the second week. As there had been no improvement, he was plasmapheresed with 7 sessions of plasma exchange, 50 ml/kg of plasma at each session, including appropriate replacement fluid. After failing to improve within 8 weeks, he was started on intravenous methylprednisolone and a dramatic improvement was observed by the 5th day. He continued to get better on oral prednisolone, was ambulatory with support 4 weeks later and could walk without support on follow-up. CONCLUSION: This case illustrates that there is a subset of patients initially diagnosed with GBS who do not respond to immunoglobulins or plasmapheresis but do specifically well on steroids. Hence treatment with prednisolone should not be delayed in selective cases of GBS as it may actually be a first episode of CIDP. SN - 1423-0151 UR - https://www.unboundmedicine.com/medline/citation/18685286/Corticosteroids_can_help_distinguish_between_Guillain_Barré_syndrome_and_first_attack_of_chronic_inflammatory_demyelinating_neuropathy:_an_illustrative_case_report_ L2 - https://www.karger.com?DOI=10.1159/000141510 DB - PRIME DP - Unbound Medicine ER -