Acute inflammatory sensorimotor polyradiculoneuropathy associated with immune thrombocytopenic purpura

Abstract

Abstract. Sato N, Kamata T, Akiyama N, Kuwana M, Kanda T (Tokyo Metropolitan Bokutoh Hospital, Tokyo; Keio University School of Medicine, Tokyo; and Yamaguchi University School of Medicine, Ube; Japan). Acute inflammatory sensorimotor polyradiculoneuropathy associated with immune thrombocytopenic purpura (Case Report). J Intern Med 2005; 257: 473-477.Although acute inflammatory polyneuropathy (AIP) and immune thrombocytopenic purpura (ITP) are both believed to be immune-mediated disorders, only a few cases have been reported in which these two diseases co-existed. We describe a case of a 67-year-old patient who developed quadriparesis, ophthalmoplegia and severe sensory impairment along with thrombocytopenia. Detailed examinations, including the measurement of anti-ganglioside antibodies and anti-glycoprotein-IIb-IIIa-IgG-producing B-cells, revealed that he developed AIP and ITP. By reviewing past similar reports, we noticed that AIP associated with ITP tends to manifest severe sensory impairment and is often preceded by upper respiratory tract infection, but not by gastrointestinal infection.

Fisher Syndrome Associated with Immune Thrombocytopenic Purpura

“…On the other hand, it is also considered that some infectious agents including HP, CMV or varicella-zoster virus is related to disease development in some patients with ITP (10). Interestingly, previously reported patients with GBS and ITP (3)(4)(5)(6)(7)(8) as well as the present patient had preceding URI. Although the mechanism of association with GBS/FS and ITP is unclear, there is the possibility that a certain infectious agent causing URI may have epitopes of both ganglioside constituent of nerve tissue and platelet-surface glycoprotein, leading to the cooccurrence of GBS/FS and ITP.…”

“…Meanwhile, a major target of ITP is the glycoprotein IIb/IIIa complex, which is expressed on the platelet surface (2). As previously discussed in cases of GBS associated with ITP, ganglioside constituents of platelets differ from those of nerve tissue, and glycoprotein IIb/IIIa complex is not expressed in nerve tissue (6). It is unlikely that the association of ITP with GBS or FS can be simply attributed to the common antigen between the nerve tissue and platelets.…”

“…Immune thrombocytopenic purpura (ITP) is also considered an autoimmune disorder characterized by platelet depletion and mucocutaneous bleeding (2). Although associations between GBS and ITP have been reported (3)(4)(5)(6)(7)(8), there have not been any reports of FS associated with ITP. We describe a patient with FS and ITP that developed after upper respiratory infection (URI).…”

Guillain–Barré syndrome after rituximab in a patient with idiopathic thombocytopenic purpura: a causal association?

“…Without any evidence of a preceding infection, this case could well be the 11th example in the literature on the coexistence of ITP and GBS [2][3][4][5][6][7][8][9][10][11]. In contrast with the current case, however, in the already reported cases of such an association, both GBS and ITP developed simultaneously.…”

Haemophilus Influenzae Associated Guillain Barre Syndrome with Thrombocytopenic Purpura and Hyperthermia

“…The association of thrombocytopenia and GBS is uncommon, with only eight reports found in our review of the literature. However of these case reports, six were female and six of the eight had a preceding upper respiratory tract infection [5][6][7][8][9][10][11][12] . In our case there was no demonstrable reason for thrombocytopenia.…”