Guillain–Barré syndrome occurring synchronously with systemic lupus erythematosus as initial manifestation treated successfully with low-dose cyclophosphamide
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 tingl...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Greater Baltimore Medical Center
2016-04-01
|
| Series: | Journal of Community Hospital Internal Medicine Perspectives |
| Subjects: | |
| Online Access: | http://www.jchimp.net/index.php/jchimp/article/view/30689/pdf_29 |
| _version_ | 1797966177707753472 |
|---|---|
| author | Naveed Ali Ritesh Rampure Faizan Malik Syed Imran Mustafa Jafri Deepa Amberker |
| author_facet | Naveed Ali Ritesh Rampure Faizan Malik Syed Imran Mustafa Jafri Deepa Amberker |
| author_sort | Naveed Ali |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T02:10:31Z |
| format | Article |
| id | doaj.art-57696710399042d180cbdcb5da0d564c |
| institution | Directory Open Access Journal |
| issn | 2000-9666 |
| language | English |
| last_indexed | 2024-04-11T02:10:31Z |
| publishDate | 2016-04-01 |
| publisher | Greater Baltimore Medical Center |
| record_format | Article |
| series | Journal of Community Hospital Internal Medicine Perspectives |
| spelling | doaj.art-57696710399042d180cbdcb5da0d564c2023-01-03T02:08:08ZengGreater Baltimore Medical CenterJournal of Community Hospital Internal Medicine Perspectives2000-96662016-04-01621410.3402/jchimp.v6.3068930689Guillain–Barré syndrome occurring synchronously with systemic lupus erythematosus as initial manifestation treated successfully with low-dose cyclophosphamideNaveed Ali0Ritesh Rampure1Faizan Malik2Syed Imran Mustafa Jafri3Deepa Amberker4 Department of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA Department of Hospitalist Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA Department of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA Department of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA Department of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USASystemic 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.http://www.jchimp.net/index.php/jchimp/article/view/30689/pdf_29Guillain–Barré syndromesystemic lupus erythematosusintravenous immunoglobulincyclophosphamideelectromyography |
| spellingShingle | Naveed Ali Ritesh Rampure Faizan Malik Syed Imran Mustafa Jafri Deepa Amberker Guillain–Barré syndrome occurring synchronously with systemic lupus erythematosus as initial manifestation treated successfully with low-dose cyclophosphamide Journal of Community Hospital Internal Medicine Perspectives Guillain–Barré syndrome systemic lupus erythematosus intravenous immunoglobulin cyclophosphamide electromyography |
| title | Guillain–Barré syndrome occurring synchronously with systemic lupus erythematosus as initial manifestation treated successfully with low-dose cyclophosphamide |
| title_full | Guillain–Barré syndrome occurring synchronously with systemic lupus erythematosus as initial manifestation treated successfully with low-dose cyclophosphamide |
| title_fullStr | Guillain–Barré syndrome occurring synchronously with systemic lupus erythematosus as initial manifestation treated successfully with low-dose cyclophosphamide |
| title_full_unstemmed | Guillain–Barré syndrome occurring synchronously with systemic lupus erythematosus as initial manifestation treated successfully with low-dose cyclophosphamide |
| title_short | Guillain–Barré syndrome occurring synchronously with systemic lupus erythematosus as initial manifestation treated successfully with low-dose cyclophosphamide |
| title_sort | guillain barre syndrome occurring synchronously with systemic lupus erythematosus as initial manifestation treated successfully with low dose cyclophosphamide |
| topic | Guillain–Barré syndrome systemic lupus erythematosus intravenous immunoglobulin cyclophosphamide electromyography |
| url | http://www.jchimp.net/index.php/jchimp/article/view/30689/pdf_29 |
| work_keys_str_mv | AT naveedali guillainbarresyndromeoccurringsynchronouslywithsystemiclupuserythematosusasinitialmanifestationtreatedsuccessfullywithlowdosecyclophosphamide AT riteshrampure guillainbarresyndromeoccurringsynchronouslywithsystemiclupuserythematosusasinitialmanifestationtreatedsuccessfullywithlowdosecyclophosphamide AT faizanmalik guillainbarresyndromeoccurringsynchronouslywithsystemiclupuserythematosusasinitialmanifestationtreatedsuccessfullywithlowdosecyclophosphamide AT syedimranmustafajafri guillainbarresyndromeoccurringsynchronouslywithsystemiclupuserythematosusasinitialmanifestationtreatedsuccessfullywithlowdosecyclophosphamide AT deepaamberker guillainbarresyndromeoccurringsynchronouslywithsystemiclupuserythematosusasinitialmanifestationtreatedsuccessfullywithlowdosecyclophosphamide |