An unusual case of recurrent Guillain-Barré syndrome with normal cerebrospinal fluid protein levels: a case report.
BACKGROUND
Guillain-Barré syndrome is an acquired polyradiculo-neuropathy, often preceded by an antecedent event. It is a monophasic disease but a recurrence rate of 1-6 % is documented in a subset group of patients. Patients with Guillain-Barré syndrome show cerebrospinal fluid albuminocytologic dissociation. Normal cerebrospinal fluid protein levels during both initial and recurrent episodes of Guillain-Barré syndrome is a rare occurrence and has not been described earlier in the literature.


METHODS
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.


CONCLUSIONS
Recurrence of Guillain-Barré syndrome can occur in a subset of patients with Guillain-Barré syndrome even after many years of asymptomatic period. Normal cerebrospinal fluid profile does not exclude Guillain-Barré syndrome and may occur in subsequent recurrences of Guillain-Barré syndrome arising the need for further studies to identify the pathophysiology and the possibility of a different subtype of Guillain-Barré syndrome.
Teaching Hospital, Kandy, Sri Lanka. sonaligunatilake@gmail.com.
Sonali Sihindi Chapa
http://orcid.org/0000-0003-0636-350X
SS
Gunatilake
Teaching Hospital, Kandy, Sri Lanka.
Rohitha
R
Gamlath
Teaching Hospital, Kandy, Sri Lanka.
Harith
H
Wimalaratna
D000328:Adult; D002556:Cerebrospinal Fluid Proteins / Q000134:cerebrospinal fluid*; D005260:Female; D020275:Guillain-Barre Syndrome / Q000134:cerebrospinal fluid* / Q000188:drug therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D012008:Recurrence
D002556:Cerebrospinal Fluid Proteins; D016756:Immunoglobulins, Intravenous
Acute inflammatory demyelinating polyneuropathy; Albuminocytologic dissociation; Case report; Cerebrospinal fluid; Guillain-Barré syndrome