title: Guillain-Barré syndrome occurring synchronously with systemic lupus erythematosus as initial manifestation treated successfully with low-dose cyclophosphamide.
abstract: Systemic lupus erythematous (SLE) is frequently encountered in clinical practice; a widespread immunological response can involve any organ system, sometimes leading to rare and diagnostically challenging presentations. We describe a 38-year-old female who presented with symmetric numbness and tingling of the hands and feet, and cervical pain. Imaging studies were not diagnostic of any serious underlying pathology. The patient developed ascending paresis involving lower extremities and cranial muscles (dysphagia and facial weakness). Guillain-Barré syndrome (GBS) was diagnosed on the basis of electromyography and lumbar puncture showing albuminocytologic dissociation. Intravenous immunoglobulins (IVIG) were administered for 5 days. Supported by anti-dsDNA antibody, oral ulcers, proteinuria of 0.7 g in 24 h, and neurological manifestation, she was diagnosed with lupus. After completion of IVIG, she received pulse-dose corticosteroids and one dose of low-dose cyclophosphamide. Her neurological symptoms improved and she had complete neurological recovery several months after her initial presentation. Literature search provides evidence of co-occurrence of lupus and GBS occurring mostly later in the course of the disease. However, GBS as initial manifestation of SLE is exceedingly rare and less understood. The association of GBS with lupus is important to recognize for rapid initiation of appropriate therapy and for consideration of immunosuppressive therapy which may affect the outcome.
authors.affiliation: Department of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA; nali@abingtonhealth.org.
authors.forename: Naveed
authors.initials: N
authors.lastname: Ali
authors.affiliation: Department of Hospitalist Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA.
authors.forename: Ritesh
authors.initials: R
authors.lastname: Rampure
authors.affiliation: Department of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA.
authors.forename: Faizan
authors.initials: F
authors.lastname: Malik
authors.affiliation: Department of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA.
authors.forename: Syed Imran Mustafa
authors.initials: SI
authors.lastname: Jafri
authors.affiliation: Department of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA.
authors.forename: Deepa
authors.initials: D
authors.lastname: Amberker
keywords: Guillain–Barré syndrome; cyclophosphamide; electromyography; intravenous immunoglobulin; systemic lupus erythematosus