Is Guillain–Barre syndrome following chickenpox a parainfectious disease? A case report and literature review

Abstract

Background Polyradiculoneuropathy following infection with varicella zoster virus (VZV) is rare and most of the time, happens in the context of reactivation of latent VZV. We report a case of acute polyradiculoneuropathy following primary infection with VZV marked by atypical clinical features raising the hypothesis of a para-infectious disease. Case presentation We describe a 43-years-old male who developed ataxia, dysphagia, dysphonia, and oculomotor disorders (vertical binocular diplopia and bilateral ptosis) followed by quadriplegia with areflexia which occurred 4 days later. The patient had a history of varicella that occurred 10 days before the onset of these symptoms. Nerve conduction study revealed features consistent with an acute motor-sensory axonal neuropathy (AMSAN). Anti-ganglioside antibodies were negative. Based on clinical presentation and ancillary examination, we retain the Miller Fisher/Guillain-Barré overlap syndrome diagnosis. The patient was treated with high doses of methylprednisolone but the evolution of the disease was nevertheless marked by a complete recovery six weeks after onset of symptoms. Conclusion GBS following varicella is a rare but severe disease occurring most often in adults and marked by greater involvement of the cranial nerves. Its clinical features suggest that it is a para-infectious disease. Antiviral therapy has no effect on the course of the disease but its administration within the first 24 h after the onset of chickenpox in adults can prevent its occurrence.

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

“…Although molecular mimicry with C. jejuni has been demonstrated, Fig. 1 Herpes zoster rash over the right face molecular mimicry with varicella zoster and peripheral nerves has not been confirmed [38,39].…”

“…The postulated hypotheses are molecular mimicry or the deranged immune system in the host, particularly of the lymphocyte subtypes. Although molecular mimicry with C. jejuni has been demonstrated, molecular mimicry with varicella zoster and peripheral nerves has not been confirmed [ 38 , 39 ].…”

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

“…152 The implementation of rehabilitation has demonstrated efficacy in GBS patients, yielding positive outcomes in research where the GBS-Disability Score was employed to assess rehabilitation's effectiveness. 153 Several case reports have described GBS following VZV infection. An adult developed GBS after contracting VZV for the first time, another adult developed GBS 3 weeks after contracting VZV and exhibited altered consciousness and flaccid paralysis of the legs, an elderly patient developed GBS after contracting VZV, and an asymptomatic VZV infection manifested as GBS.…”

“…These manifestations can range in intensity from mild to severe, occasionally progressing to paralysis 152 . The implementation of rehabilitation has demonstrated efficacy in GBS patients, yielding positive outcomes in research where the GBS‐Disability Score was employed to assess rehabilitation's effectiveness 153 …”