[Guillain-Barré syndrome in a child with normal tendon reflexes]

Area of Science:

• Neurology
• Immunology

Background:

• Guillain-Barré syndrome (GBS) is an autoimmune disorder affecting the peripheral nervous system.
• The acute motor axonal neuropathy (AMAN) subtype is characterized by motor axonal degeneration.
• Typically, GBS presents with diminished or absent tendon reflexes.

Observation:

• A 10-year-old child developed distal limb weakness 6 days post-gastroenteritis.
• The child presented with preserved tendon reflexes, elevated CSF protein, and no cells.
• Nerve conduction studies confirmed motor axonal degeneration consistent with GBS.

Findings:

• The patient's serum tested positive for IgG antibodies against gangliosides GM1 and GD1b.
• This case demonstrates GBS, specifically the AMAN form, can occur in children with normal tendon reflexes.
• Unlike previously reported adult cases, this pediatric case expands the understanding of AMAN presentations.

Implications:

• This case challenges the traditional diagnostic criteria for GBS, emphasizing that preserved reflexes do not exclude the diagnosis.
• It underscores the importance of considering AMAN in pediatric patients with unexplained limb weakness and normal reflexes.
• Early identification and treatment with intravenous immunoglobulins (IVIg) can lead to positive clinical outcomes in pediatric GBS.