Guillain–Barré and Acute Transverse Myelitis Overlap Syndrome Following Obstetric Surgery

Abstract

Introduction:There are rare reports of the occurrence of acute transverse myelitis and Guillain-Barré syndrome after various surgical procedures and general/epidural anaesthesia. The concomitant occurrence of these pathologies is very rare and is called Guillain-Barré and acute transverse myelitis overlap syndrome. In this article, we present the case of a second trimester pregnant patient who developed Guillain-Barré and acute transverse myelitis overlap syndrome. Case presentation: We report the case of a 16-year-old female patient who underwent a therapeutic termination of pregnancy two weeks prior to the onset of the disease with gradual development of a motor deficit with walking and sensitivity disorders, fecal incontinence. The diagnosis was based on clinical exam, electroneurography and spinal magnetic resonance imaging. Endocrinopathies, infectious diseases, autoimmune and inflammatory diseases, neoplastic diseases and vitamin deficiencies were ruled out. Our patient attended five sessions of therapeutic plasma exchange, followed by steroid treatment, intravenous immunoglobulin with minimum recovery of the motor deficit in the upper limbs, but without significant evolution of the motor deficit in the lower limbs. The patient was discharged on maintenance corticotherapy and immunosuppressive treatment with azathioprine. Conclusions: We report a very rare association between Guillain-Barré syndrome and acute transverse myelitis triggered by a surgical intervention with general anaesthesia. The overlap of Guillain-Barré syndrome and acute transverse myelitis makes the prognosis for recovery worse, and further studies are needed to establish the first-line therapy in these cases.

Therapeutic plasma exchange as a first‑choice therapy for axonal Guillain‑Barré syndrome: A case‑based review of the literature (Review)

“…Clinical and epidemiological observations show that GBS is associated with a preceding illness, and 75% of patients report acute enterocolitis or upper respiratory infection ( 26 ). The most frequent pathogens involved are C. jejuni , cytomegalovirus (CMV), Epstein-Barr virus (EBV), Zika, post-flu or other events involving immunization with vaccines such as rabies vaccines ( 27 , 28 ), surgery and anesthesia ( 5 ). In the case of AMAN, the most frequently involved pathogen is C. jejuni ( 15 ).…”

“…Generally, patients with AMAN are thought to have poor prognosis compared with patients with AIDP ( 5 ), but some patients with AMAN often show rapid recovery, and Hiraga et al described these patterns of evolution in a study that included patients with GBS who received immune treatments ( 3 ). Out of a total of 35 patients with the AMAN phenotype of GBS who were analyzed for neurological evolution, 19 had a 1 point improvement on the HFGS at 4 weeks; in the other patients, the 1-point improvement was delayed by >1 month ( 3 ).…”

“…From the neurophysiological point of view, the following phenotypes of GBS are described: Acute inflammatory demyelinating polyradiculoneuropathy (AIDP), Miller Fisher syndrome and acute autonomic neuropathy (4) and the axonal variants, acute motor sensory neuropathy (AMSAN) and acute motor axonal neuropathy (AMAN). Axonal variants were first recognized in northern China and then reported in other countries (3,5).…”

“…Although modern methods of treatment such as therapeutic plasma exchange (TPE) and intravenous immunoglobulins (IVIg) have significantly improved the prognosis, many patients nevertheless experience significant neurological sequelae ( 5 , 18 ).…”

Atypical Variant of Guillain Barre Syndrome in a Patient with COVID-19

“…The inciting event that triggers this immunological reaction includes vaccinations, pregnancy, and surgical procedures but is often precipitated by infection [ 6 , 7 ]. Common antecedent infections include Campylobacter jejuni, Mycoplasma pneumoniae, Cytomegalovirus, Epstein-Barr virus, influenza A and the Zika virus [ 4 , 8 ].…”