title: Complicated acute motor axonal neuropathy with delayed acute respiratory distress syndrome and rapidly progressive glomerulonephritis: a case report.
abstract: OBJECTIVE
  Acute motor axonal neuropathy (AMAN), a variant of Guillain Barre syndrome (GBS), is frequently induced by the antecedent infection of some atypical pathogen, such as Campylobacter jejuni, Mycoplasma pneumonia and some virus. It is generally accepted that corticosteroids and immunosuppressants are not recommended in patients with GBS including AMAN. However, if systemic autoimmune reaction developed, the principle of management might be changed.
  
  
  METHODS
  We report a young man who rapidly developed acute motor axonal neuropathy. Although plasma exchange had been given, the violent immunological reaction was unable to be controlled, prolonged leukemoid reaction and high level of autoimmunological titers, including C-reactive protein (CRP), rheumatoid factor (Rf), and antineutrophil cytoplasmic autoantibody (ANCA) persisted. Consequently, two months later, this patient developed acute respiratory distress syndrome (ARDS) and type 3 of rapidly progressive glomerulonephritis (RPGN) with rapid decline of renal function until immunosuppressants were given.
  
  
  CONCLUSIONS
  AMAN combined with the violent systemic autoimmune reaction strongly indicated an uneven disease course and implied that only standard plasmapheresis is not sufficient and corticosteroids with immunosuppressant should be added in early stage.
authors.affiliation: Department of Neurology, Chung-Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: An-Chih
authors.initials: AC
authors.lastname: Chen
authors.forename: Chiu-Mei
authors.initials: CM
authors.lastname: Chen
authors.forename: Horng-Rong
authors.initials: HR
authors.lastname: Chang
authors.forename: Kai-Jieh
authors.initials: KJ
authors.lastname: Yeo
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Tsao
authors.forename: Pei-Ching
authors.initials: PC
authors.lastname: Hsiao
authors.forename: Shih-Jei
authors.initials: SJ
authors.lastname: Tsai
mesh_terms: D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D018501:Antirheumatic Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism; D003401:Creatine / Q000097:blood; D003520:Cyclophosphamide / Q000494:pharmacology; D005921:Glomerulonephritis / Q000150:complications*; D020275:Guillain-Barre Syndrome / Q000150:complications*; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000503:physiopathology; D009431:Neural Conduction / Q000502:physiology; D012128:Respiratory Distress Syndrome / Q000150:complications*; D012217:Rheumatoid Factor / Q000097:blood
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D018501:Antirheumatic Agents; D003520:Cyclophosphamide; D002097:C-Reactive Protein; D012217:Rheumatoid Factor; D003401:Creatine