Temporal arteritis and Guillain-Barré syndrome

The association of temporal arteritis and Guillain-Barré syndrome has rarely been reported. We describe a patient who sequentially suffered from both disorders. An 81-year-old woman presented with headache and loss of appetite. Analysis showed anemia and an erythrocyte sedimentation rate of 94 mm/hr. Temporal artery biopsy disclosed giant cell arteritis. Upon treatment with prednisone, all symptoms improved. A few weeks later, the patient began having low back pain, paresthesias, ascending weakness, and unexplained intermittent hypotension. Examination showed absent tendon reflexes in the knees. Cerebrospinal fluid contained one mononuclear cell/dL, and a protein level of 81 mg/dL. An electrophysiologic study revealed reduced nerve conduction velocities. Intravenous immunoglobulin therapy was instituted, and all symptoms slowly disappeared. This is the third reported case of Guillain-Barré syndrome in association with temporal arteritis. The other two patients recovered. Although the association of Guillain-Barré syndrome and temporal arteritis in these three patients could be coincidental, a common immunologic mechanism is also a possibility.