Guillain–Barré syndrome following varicella–zoster virus infection: a case report and systematic review

Abstract

Background: Guillain–Barré syndrome (GBS) is an acute inflammatory disease of the peripheral nervous system, rarely following Varicella–zoster virus (VZV) infection. The authors aimed to review all cases in the English literature of GBS that occurred after primary VZV infection to investigate the clinical features, diagnostic workup, treatment, and outcome of patients with GBS following VZV. Methods: PubMed, Scopus, and Embase are systematically searched from their inception to 9 May 2022 to collect all cases of GBS following varicella–zoster infection. Patients with GBS following VZV reactivation were excluded. Results: Among the 29 patients, the age of presentation ranged from 1.5 to 70 years with a median of 37, with a yield for males (81.5%). Most of the patients presented with sensory-motor symptoms (65.4%) and suffered from tetraparesis (81.5%). Cranial nerve palsy was present in (84%) of patients, and the seventh cranial nerve was the most commonly affected nerve (75%). Lumbar puncture showed albuminocytological dissociation in (80%) of patients. The dominant nerve conduction study subtype was acute inflammatory demyelinating polyneuropathy (65.3%). in addition, the magnetic resonance imaging showed pathological findings in only (47.5%) of the patients. Intravenous immunoglobulin is now the drug of choice for all cases of GBS following VZV infection. Conclusion: GBS is a rare neurological complication of primary infection with VZV. However, the authors should suspect this syndrome when a patient develops ascending weakness, regardless of the absence of areflexia and albuminocytological dissociation. Drug therapy with IIVIg ensures a gradual improvement for the patient over a period of weeks to several months.

Guillain–Barre syndrome of acute motor axonal neuropathy (AMAN) type associated with herpes zoster: a case report

“…The neurophysiological subtype of GBS has not been reported in most published cases of zoster-related GBS. Where specified, it had been of the acute inflammatory demyelinating polyradiculoneuropathy (AIDP) type [ 6 – 9 ]. Our patient had GBS of the acute motor axonal neuropathy (AMAN) type.…”

“…Acute varicella infection (chicken pox) is a rare trigger for GBS [ 3 ], and GBS following varicella infection is usually of the AIDP type [ 6 – 9 ]. A recent review identified 88% of the GBS cases following varicella infections to be of the AIDP type, and 13% axonal type [ 6 , 7 , 10 – 28 ].…”

“…GBS can rarely manifest following some vaccines such as measles, rabies, influenza, measles and MMR [2]. More recently, GBS has been reported following SARS-CoV-2 infection and COVID-19 vaccination [4,5] Acute varicella infection (chicken pox) is a rare trigger for GBS [3], and GBS following varicella infection is usually of the AIDP type [6][7][8][9]. A recent review identified 88% of the GBS cases following varicella infections to be of the AIDP type, and 13% axonal type [6,7,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

Varicella‐zoster virus‐related neurological complications: From infection to immunomodulatory therapies

“…This suggests that while VZV infection can be a trigger for GBS in some individuals, it is not a common cause of the syndrome. 158,159 F I G U R E 3 This figure illustrates the mechanism underlying the activation of central nervous system-reactive T cells in MS. It depicts the initiation of immune responses, infiltration of T cells into the central nervous system, and subsequent inflammatory processes.…”

“…In fact, just one percent of GB cases are related to VZV. This suggests that while VZV infection can be a trigger for GBS in some individuals, it is not a common cause of the syndrome 158,159 …”