title: Case report: Guillain-Barré syndrome following renal transplantation--a diagnostic dilemma.
abstract: BACKGROUND
  Guillain-Barré syndrome (GBS) is an acute polyneuropathy caused by an autoimmune response towards a foreign antigen, notably viral infections. It is characterised by a symmetrical ascending paralysis with treatment remaining largely supportive; however, plasma exchange or intravenous immunoglobulins can be used to shorten recovery time.
  
  
  METHODS
  We describe a case of severe acute GBS in a patient post-renal transplantation. The 44-year-old gentleman's induction therapy consisted of methyl prednisolone and basiliximab, with subsequent tacrolimus and mycophenolate mofetil as immunosuppressive agents. Tacrolimus was discontinued immediately on suspicion of a temporal relationship with the patient's condition, and substituted with a combination of ciclosporin, mycophenolate mofetil and prednisolone. Due to extensive patient screening prior to transplant, negative virology/immunology and normal nerve biopsy findings, both tacrolimus and basiliximab may be indicated as causative agents.
  
  
  CONCLUSIONS
  Immunosuppressive-induced GBS should be considered a differential diagnosis in patients on tacrolimus or basiliximab with acute-onset limb weakness, especially if recently commenced. Discontinuation of tacrolimus and initiation of plasma exchange for the treatment for tacrolimus-associated GBS may be beneficial.
authors: Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors: Adam D
authors: AD
authors: Jakes
authors: Poonam
authors: P
authors: Jani
authors: Sunil
authors: S
authors: Bhandari
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D006084:Graft Rejection / Q000175:diagnosis / Q000517:prevention & control*; D020275:Guillain-Barre Syndrome / Q000139:chemically induced* / Q000175:diagnosis*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D016559:Tacrolimus / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus