Abstract
Background: Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuro-radiculopathy and known to follow a variety of viral, mycoplasmal, bacterial and chlamydial infections. The association with tuberculosis has been exceptionally reported. We report an unusual case of GBS associated with pulmonary tuberculosis.
Case report: An 19-year-old man was admitted to hospital with cough during one month and hemoptysis. Chest X-ray showed multiple ring shadows in both upper zones suggestive of pulmonary tuberculosis. Sputum-smears and culture were positives for mycobacterium tuberculosis. Anti-TB drugs were initiated and they were well tolerated. Twenty one days later, the patient suffered acute and progressive legs weakness that ascended to the arms and face with sensory loss and flaccid of 4 limbs. Cranial computer tomography and magnetic resonance imaging were normal. Antibodies to nuclear antigens were negative. Cerebrospinal fluid (CSF) revealed protein 210 mg/dl, sugar 75 mg/dl without cells. Neurophysiological study was consistent with sensitive- motor axonal and radicular neuropathy with denervation. These clinical, radiological and laboratory investigations were conform to description of GBS. Intravenous immunoglobulin therapy (0.4 g/kg over 5 days) and physiotherapy were given, with slow neurological recovery. At review 6 months later, patient had completely recovered.
Conclusion: The pathogenesis of GBS in infective disease is by no means clear. Authors suggested that GBS can be resulted from direct invasion of the nerve roots by tubercle bacilli.
- © 2011 ERS
