title: An adolescent with pharyngeal-cervical-brachial variant of Guillain-Barré syndrome after cytomegalovirus infection.
abstract: A 15-year-old Japanese girl developed bulbar palsy and upper limb-dominant muscle weakness 2 weeks after the onset of an upper respiratory tract infection due to cytomegalovirus (CMV). Her symptoms resembled that seen in the pharyngeal-cervical-brachial variant (PCB) of Guillain-Barré syndrome (GBS). Although bulbar palsy usually continues for several months in PCB, her bulbar palsy was very mild and improved rapidly before intravenous immunoglobulin therapy was instituted. Serum anti-GT1a IgG antibody titer was elevated at the acute phase of the disease and gradually decreased. The bulbar palsy-dominant GBS is thought to relate to anti-GT1a antibody and Campylobacter jejuni infection in adult patients. Our Case report suggests that CMV can also induce the production of anti-GT1a antibody, thereby resulting in PCB. When one sees acute onset bulbar palsy and limb muscle weakness, the possibility of PCB, even in children, should be considered, thus compelling the need for serum anti-ganglioside antibody measurement.
authors.affiliation: Department of Pediatrics, Koshigaya Hospital, Dokkyo University School of Medicine, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan. nobuyuki@dokkyomed.ac.jp
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Murakami
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Tomita
authors.forename: Michiaki
authors.initials: M
authors.lastname: Koga
authors.forename: Etsuro
authors.initials: E
authors.lastname: Takahashi
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Katada
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Sakuta
authors.forename: Toshiro
authors.initials: T
authors.lastname: Nagai
mesh_terms: D000293:Adolescent; D001132:Arm / Q000294:innervation / Q000503:physiopathology; D010244:Bulbar Palsy, Progressive / Q000209:etiology* / Q000503:physiopathology; D003586:Cytomegalovirus Infections / Q000150:complications*; D005260:Female; D005732:Gangliosides / Q000276:immunology; D020275:Guillain-Barre Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D018908:Muscle Weakness / Q000209:etiology* / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009334:Neck Muscles / Q000294:innervation / Q000503:physiopathology; D010608:Pharyngeal Diseases / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D005732:Gangliosides; D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; C016481:trisialoganglioside GT1