Rosalia Shivute
Guillain-Barre© syndrome and its variants form a continuous spectrum of overlapping syndromes. A 15-year-old caucasian male patient previously well presented with a week history of body weak-ness, vomiting and neck pain, (pre Covid pandemic). Further history noted that he suffered multiple infantile apnoeic attacks with mild cognitive impairment. He disclosed that he had an upper respiratory infection 3 weeks prior treated with fluroquinolones by a general practitioner. On examination he was noted to be febrile. Positive finding included terminal neck stiffness and a sinus tachycardia. All other systems and vitals were normal. Initial CTB was normal with an unremarkable lumbar puncture. Day 5 of admission the patient developed bulbar symptoms; a repeat LP was done where albuminocytogical dissociation was noted. Higher mental function normal, bilateral facial nerve palsy, facial diplegia with decrease palatal movement, an absent gag reflex. It was noted that the patient had significant proximal weakness of upper and lower limbs. Deep tendon reflexes were all decreased with no sensory fallout and no cerebellar signs. Diagnosis of a rare regional variant of Guillan Barre Syndrome (GBS) was clinically made. Immunoglobulin was commenced. The patient responded rapidly to treatment.
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