CaseG

Introduction

Guillain-Barre´ syndrome is an acute inflammatory demyelinating polyradiculoneuropathy characterized by progressive muscle weakness, areflexia and sensory abnormalities.1 It is believed to be a result of humoral and cellular responses directed against peripheral nerves. 1,2 Campylobacter jejuni is believed to be the most frequent identifiable infection. Guillain-Barre´ syndrome is a rare complication in the setting of hematopoietic stem cell transplantation. 3-6 There are some case reports of GBS after bone marrow transplantation. It is very rare in solid organ transplants.3 Guillain-Barre´ syndrome is also reported in one case after heart transplantation with partial response to plasmapheresis.7

Two patients with typical GBS characteristics have been reported after kidney transplantation. They partially responded to standard therapies which are plasmapheresis and hyperimmune gammaglobuline.8 The conventional treatment for GBS was used in these cases with partial response.

Case Presentation

A 48-years-old man, a case of unexplained chronic renal failure underwent renal transplant from an unrel ated donor two months before admission in neurology ward. He was on immunosuppressive therapy with prednisolone, mycophenolate mofetil and tacrolimus and his renal function tests were in normal range. Two months after transplantation he presented with symmetrical weakness of both lower extremities with an ascending pattern and progression to upper limbs within one week. He also complained of dysphagia and mild dyspnea but had no sphincteric problem. Neurological examination revealed decreased muscle power in both lower and upper limbs (3/5 and 4/5 respectively). All deep tendon reflexes were absent (0/2). Lumbar puncture showed high protein (61 mg/dL), normal cell count (RBC: 0, WBC: 3 all lymphocytes), sugar (54 mg/dL) and pressure (15cm H2O) of cerebrospinal fluid. Antibodies to monosialotetrahexosylganglioside (Anti GM1) were not checked. Electrodiagnostic studies (electromyography and nerve conduction velocity) confirmed the diagnosis of GBS. He was treated with 5 sessions of plasma exchange, without significant improvement in his neurologic state. He was discharged and physiotherapy was done outside the hospital. After two months of follow up, he had residual weakness and was unable to walk independently.

Discussion

We reported a novel case of Guillain-Barre´ syndrome following solid organ transplantation in an Iranian man which is assumed to be a very rare complication. Graft versus host disease and side effect of drugs should be ruled out before diagnosing GBS. Our patient and the donor did not have familial consanguinity, so considering this and other clinical data, graft versus host disease was less likely. He was not taking the drugs for a long period, so we did not expect this presentation to be side effect of the drugs after such a short period of time. Guillain-Barre´ syndrome was the diagnosis as physical examination and electrodiagnostic studies confirmed it. It was one of the rare cases of GBS following solid organ transplantation. We did not detect much recovery in our case after treatment with plasmapheresis. Guillain-Barre´ syndrome happens rarely after organ transplant 9 but it should be kept in mind in a patient presenting with weakness after transplantation. In this case conventional treatments did not result in significant change and improvement in GBS outcome.

Acknowledgments

Authors wanted to appreciate the scientific writing and editing of the manuscript by scientific writing committee of Sadra-tech™ Company, Shiraz University of Medical Sciences, Shiraz, Iran.