Concurrent Acute Motor and Sensory Axonal Neuropathy and Immune Thrombocytopenic Purpura

Ward, I. M.; Fewell, Allyson E.; Ferraro, David; Morris, Michael

doi:10.7205/milmed-d-12-00306

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…There is thus far, no known common receptor or process that has linked both GBS and ITP. However, as molecular mimicry is the underlying mechanism for both these diseases, there is a chance for both these entities to co-occur in the same patient as was the case with our patient and a few other patients in the literature 1,4 .…”

Section: Discussionsupporting

confidence: 63%

“…Gullian-Barre syndrome (GBS) is a disease in which there is typically damage to myelin surrounding peripheral nerves and typically presents as the classic ascending weakness, paresthesias, and numbness, all potentially in the setting of a preceding infection; this pattern is particularly associated with the GBS-subtype of Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) 1,2 . There are several other variants of GBS, one of which is Acute Motor and Sensory Axonal Neuropathy (AMSAN), which carries a worse prognosis and causes axonal injury rather than pure demyelination 1,3 . Compared to AIDP, AMSAN patients tend to progress much more quickly, have a higher chance of becoming debilitated and quadriparetic and have a longer time for recovery.…”

Section: Discussionmentioning

confidence: 99%

“…This illustrates the heterogeneity of presentation and treatment even in patients with AMSAN. There have been at least a few cases of various different subtypes of GBS and ITP suggesting that while it is a rare occurrence, there does seem to be some underlying process that increases the risk of an additional autoimmune reaction in a patient already suffering from one 1,7,8,9,10,11,12,13,14,15 . Finally, this case does highlight the unique management and diagnostic decision-making in a patient with both ITP and AMSAN.…”

Section: Discussionmentioning

confidence: 99%

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A rare case of Acute Motor and Sensory Axonal Neuropathy (AMSAN) and Immune Thrombocytopenic Purpura (ITP) related to Hemophilus influenzae

Satyasi¹,

Ahmed²,

Farheen

2021

rrnmf

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We describe a rare case presenting with both signs of acute motor and sensory axonal neuropathy (AMSAN) and immune thrombocytopenic purpura (ITP) possibly triggered by Hemophilus influenzae. Guillain-Barre is an autoimmune disorder purported to be due to molecular mimicry, often with a preceding infection, leading to myelin sheath or even axonal damage, AMSAN, in the peripheral nervous system (PNS). Rarely, there have been case reports of concurrent acute autoimmune disorders leading to a more complex presentation and additional comorbidities. A 42-year-old man presented with 2 days of progressive lower and upper extremity paresthesia’s, ataxia preceded by an upper respiratory infection. Examination showed areflexia and purpura, recent oral mucosal hemorrhage. Lab results showed severe thrombocytopenia suspicious for ITP. Over the ensuing weeks while inpatient, his condition quickly deteriorated to requiring an intubation for respiratory failure and not immediately responsive to IVIG. Recovery, both for AMSAN confirmed by EMG and ITP, was eventually achieved with time and five treatments of plasmapheresis and eventually was discharged to a rehabilitation facility. A thorough infectious workup revealed a possible trigger being Haemophilus influenzae. There have been rare occasions of concurrent GBS and ITP, but even more rare is the presence of both AMSAN and ITP which requires quick recognition and evaluation. This case highlights the need for a thorough initial history taking and a general physical exam, in addition to unique management decisions and strategies in patients with suspected GBS as there may be signs of other associated disorders that require immediate attention.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A rare case of Acute Motor and Sensory Axonal Neuropathy (AMSAN) and Immune Thrombocytopenic Purpura (ITP) related to Hemophilus influenzae

Satyasi¹,

Ahmed²,

Farheen

2021

rrnmf

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“…GBS has been reported with other comorbid conditions like immune thrombocytopenic purpura (ITP). Sato et al (2005) and Ian M Ward et al (2013) reported a compilation of such cases in addition to their case of concurrent GBS and ITP [ 19 , 20 ]. GBS has also been reported with posterior reversible encephalopathy syndrome (PRES), Covid-19 infections, myasthenia gravis, nephrotic syndrome, pulmonary tuberculosis to name a few [ [21] , [22] , [23] , [24] , [25] ].…”

Section: Clinical Discussionmentioning

confidence: 99%

Concurrent thrombotic thrombocytopenic purpura and Guillian Barre Syndrome post infectious diarrhea

Hussain

Kumar

Singh³

et al. 2022

Annals of Medicine &Amp; Surgery

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“…Electrophysiology studies may differentiate this subtype from the other forms of GBS. AMSAN usually presents with severe symptoms over a short period of time, and patients often experience a prolonged and incomplete recovery compared to other forms of GBS, as seen in this patient [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Axonal Variant of Guillain-Barré Syndrome following Elective Spinal Surgery

Dowling

Dowling²

2018

Case Reports in Orthopedics

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Acute motor and sensory axonal neuropathy (AMSAN) is a rare axonal variant of Guillain-Barré syndrome. AMSAN is considered the most severe form of GBS, known for its rapid onset of severe symptoms, and often leading to quadriparesis within 7 days of initial symptom onset. We present a case of a middle-aged Caucasian female who developed AMSAN 2 weeks following an elective spinal surgery. Although rare, GBS has been reported as a complication of surgery. GBS classically presents as ascending motor weakness starting in the lower extremities following a gastrointestinal or upper respiratory tract infection. This patient's GBS manifested slightly differently, with both sensory and motor symptoms of her thoracic region and lower extremities, with no preceding history indicative of infection. To the authors' knowledge, this is the first reported case of AMSAN following spinal surgery. Because of its risk of significant morbidity and mortality, as well as similar presentation to more common spinal postoperative complications, GBS should always be included in the differential diagnosis whenever motor or sensory weakness is observed after spinal surgery.

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Concurrent Acute Motor and Sensory Axonal Neuropathy and Immune Thrombocytopenic Purpura

Abstract: A review of the literature revealed eleven previous cases of concurrent GBS and ITP; however, we report the first case of concurrent AMSAN and ITP. Among these cases, trends were noted to include sex, preceding infections, and cranial nerve involvement.

Cited by 5 publications

References 17 publications

A rare case of Acute Motor and Sensory Axonal Neuropathy (AMSAN) and Immune Thrombocytopenic Purpura (ITP) related to Hemophilus influenzae

A rare case of Acute Motor and Sensory Axonal Neuropathy (AMSAN) and Immune Thrombocytopenic Purpura (ITP) related to Hemophilus influenzae

Concurrent thrombotic thrombocytopenic purpura and Guillian Barre Syndrome post infectious diarrhea

A Rare Axonal Variant of Guillain-Barré Syndrome following Elective Spinal Surgery

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