Combination of AIDP and pyramidal signs associated with antecedent hepatitis A infection: a rare (co)occurrence

Guillain-Barré syndrome (GBS) is a postinfectious illness and commonly occurs in association with infective agents such as Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, Mycoplasma pneumoniae, HIV, shigella, clostridium, Haemophilus influenzae; occasionally with acute hepatitis B, C, E; and more rarely with hepatitis A, as documented in various case reports. Classically, GBS presents with hyporeflexia or areflexia, but preserved and brisk reflexes have been described in context with GBS variant, AMAN (acute motor axonal neuropathy), in approximately 33% of the cases. Preserved or exaggerated tendon reflexes with extensor plantar response is not usually seen in patients with acute inflammatory demyelinating polyradiculoneuropathy (AIDP). We report a rare case of AIDP with upper motor neuron signs in association with an antecedent hepatitis A infection.