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Guillain-Barré syndrome in a case of acute lymphoblastic leukaemia. A case report
Periasamy Vembu1, Asmahan Al-Shubaili, Adnan Al-Khuraibet
1Ibn Sina Hospital, Kuwait. thomas_tom@go.com
Objective:
To report a case of severe Guillain-Barré syndrome in a 32-year old female patient diagnosed with acute lymphoblastic leukaemia who was on chemotherapy.
Clinical Presentation And Intervention:
The patient received chemotherapy including vincristine and steroids according to the Medical Research Council United Kingdom Acute Lymphoblastic Leukaemia-12 (MRC UKALL-12) protocol. On the 21st day of the first induction course she developed acute fulminant quadriparesis with total areflexia. The clinical features, nerve conduction and the cerebrospinal fluid studies were consistent with acute Guillain-Barré syndrome. She was treated with a 5-day course of intravenous immunoglobulins (IVIG) that resulted in only partial improvement. A second course of IVIG was given 2 weeks later that improved her condition slowly and steadily over a period of 12-16 weeks; the patient was able to walk with minimal support.
Conclusion:
The fulminant neuropathy was most likely due to the association between Guillain-Barré syndrome and leukaemia rather than vincristine neurotoxicity. IVIG was an effective and non-invasive treatment for Guillain-Barré syndrome associated with the malignancy.
