Cranial polyneuropathy with elevated serum antiganglioside antibody

Area of Science:

• Neurology
• Immunology
• Pediatrics

Background:

• Miller Fisher syndrome (MFS) and Bickerstaff's brainstem encephalitis (BBE) are rare neurological disorders.
• Antiganglioside antibodies are implicated in various autoimmune neuropathies.
• Campylobacter jejuni infection is a known trigger for Guillain-Barré syndrome and its variants.

Observation:

• A 6-year-old girl presented with cranial polyneuropathy, including palsies of the 3rd, 6th, 7th, and 12th cranial nerves, following herpetic vesicles.
• No limb weakness, ataxia, or areflexia was noted; cerebrospinal fluid and brain MRI were normal.
• Elevated serum antibodies to gangliosides GQ1b and GT1b, and Campylobacter jejuni were detected.

Findings:

• The patient's presentation suggests a variant form of Miller Fisher syndrome or Bickerstaff's brainstem encephalitis.
• The neurological deficits were associated with specific antiganglioside antibodies (GQ1b, GT1b) and Campylobacter jejuni infection.
• Treatment with methylprednisolone and acyclovir showed minimal initial effect, but spontaneous resolution of cranial nerve palsies occurred within 4 months.

Implications:

• This case highlights a potential association between cranial polyneuropathy, antiganglioside antibodies, and asymptomatic Campylobacter jejuni infection in a pediatric patient.
• It expands the spectrum of clinical presentations for anti-ganglioside antibody-associated neurological disorders in children.
• The findings contribute to understanding the pathogenesis of rare neurological syndromes and may inform diagnostic and therapeutic approaches.