Corticosteroids can help distinguish between Guillain-Barré syndrome and first attack of chronic inflammatory demyelinating neuropathy: an illustrative case report.
OBJECTIVE
To report a case of acquired demyelinating neuropathy that failed to improve upon treatment with intravenous immunoglobulins and plasmapheresis but responded dramatically to corticosteroids, illustrating the occasional difficulty in distinguishing Guillain-Barré syndrome (GBS) from a first attack of chronic inflammatory demyelinating polyneuropathy (CIDP).


METHODS
A 25-year-old previously healthy man was admitted with a 5-day history of ascending areflexic paralysis of all 4 limbs and diagnosed with GBS. On admission, he was administered intravenous immunoglobulins at a dosage of 400 mg/kg/day for 5 days yet continued to worsen. He became quadriparetic by the second week. As there had been no improvement, he was plasmapheresed with 7 sessions of plasma exchange, 50 ml/kg of plasma at each session, including appropriate replacement fluid. After failing to improve within 8 weeks, he was started on intravenous methylprednisolone and a dramatic improvement was observed by the 5th day. He continued to get better on oral prednisolone, was ambulatory with support 4 weeks later and could walk without support on follow-up.


CONCLUSIONS
This case illustrates that there is a subset of patients initially diagnosed with GBS who do not respond to immunoglobulins or plasmapheresis but do specifically well on steroids. Hence treatment with prednisolone should not be delayed in selective cases of GBS as it may actually be a first episode of CIDP.
Alexander
K John
KJ
Department of Neurology, Ibn Sina Hospital, Kuwait. drkjalex@hotmail.com
Alshubaili
Asmahan F
AF
Santhamoorthy
P
P
Sharafuddin
K M
KM
D000284:Administration, Oral; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D005938:Glucocorticoids / Q000627:therapeutic use*; D020275:Guillain-Barre Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D010243:Paralysis / Q000175:diagnosis / Q000188:drug therapy; D010956:Plasmapheresis; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D011782:Quadriplegia / Q000209:etiology; D012720:Severity of Illness Index; D017211:Treatment Failure; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D011239:Prednisolone; D008775:Methylprednisolone