Acute Motor Axonal Neuropathy Coexisting With Ankylosing Spondylitis: A Case-Based Review

Guillain-Barré syndrome (GBS) is a rare autoimmune disorder characterized by peripheral nerve involvement. Among the many kinds of GBS, acute motor axonal neuropathy (AMAN) syndrome has been shown to have distinct clinical characteristics and consequences. Meanwhile, ankylosing spondylitis (AS) is a long-term inflammatory joint illness that mostly affects the sacroiliac joints and the spine; this disorder has been known to cause discomfort and stiffness, which may lead to decreased flexibility over time. Some studies have found a link between anti-TNF α medication and GBS. GBS was commonly related to anti-TNF-α treatment for established AS, which explains the rare overlap of both diseases. In our case, nevertheless, both conditions occurred together without any confirmed therapeutic or infectious provocation. We describe a case of a 35-year-old painter hospitalized with paralysis of the lower and upper limbs but normal reflexes. Electromyography (EMG) demonstrated axonal motor neuropathy, and a lumbar puncture revealed high protein levels (42.2 mg/dL) and a normal cell count, all of which are indicators of GBS; hence, he was diagnosed with AMAN. Additional testing revealed human leukocyte antigen (HLA)-B27 positive and bilateral sacroiliitis on magnetic resonance imaging (MRI), which is consistent with AS. The administration of plasma exchange (PLEX) treatment improved the bulbar function.