2019 Volume 51 Issue 4 Pages 249-253
We report the case of a four-year-old girl who was referred to our hospital for altered consciousness and severe back pain. She exhibited various neurological symptoms such as drowsiness, multiple cranial nerve palsy (Ⅲ, Ⅳ, Ⅶ, Ⅹ, Ⅻ), muscle weakness, severe pain of back and extremities, and depressed tendon reflexes. Clinical symptoms and laboratory findings, including protein-cell dissociation of cerebrospinal fluid, lowered motor nerve conduction velocity, and lowered compound muscle action potential of tibial nerve, allowed the diagnosis of Guillain-Barré syndrome (GBS). Serum IgG-class anti-ganglioside antibodies were not detected. Treatment with high-dose intravenous immunoglobulin therapy was initiated; however, muscle weakness proceeded, and the patient required respiratory support by noninvasive positive pressure ventilation from the day 5 to 8. Subsequently, her neurological symptoms showed rapid improvement; she was ambulant on the day 19 and was discharged on the day 30. Epstein-Barr virus (EBV) was detected in the patient's serum, pharyngeal swab, and stool sample upon admission via polymerase chain reaction. Serological studies revealed that the patient experienced antecedent EBV infection for the first time. Although the patient exhibited overlapping symptoms of Fisher syndrome and Bickerstaff brainstem encephalitis, a final diagnosis of GBS with antecedent EBV infection was delivered based on the negative anti-GQ1b antibody and electrophysiological results which suggested acute inflammatory demyelinating polyneuroradiculopathy. Characteristics of GBS with antecedent EBV infection were not completely clarified. Thus, this case is reportable for a further delineation of EBV associated GBS.
