Guillain–Barré Syndrome Overlapping with Longitudinally Extensive Transverse Myelitis Associated with Isolated Anti-GD3 IgG Positivity

Abstract

Abstract Background/Aims: Guillain–Barré syndrome (GBS) overlapping with longitudinally extensive transverse myelitis (LETM) is a rare central–peripheral nervous system overlap syndrome. We aimed to present a patient with GBS–LETM overlap associated with isolated anti-GD3 IgG positivity and to emphasize the diagnostic value of serial electrophysiological assessment. MEthods: A 74-year-old man was evaluated by serial electrophysiological studies (days 2 and 10), cerebrospinal fluid analysis, cervicothoracic spinal magnetic resonance imaging, and serum ganglioside, nodal/paranodal, anti-myelin oligodendrocyte glycoprotein, and paraneoplastic antibody panels. Results: The patient developed rapidly progressive quadriplegia with generalized areflexia, a sensory level below T2, and urinary retention. Cerebrospinal fluid demonstrated albuminocytologic dissociation. The initial electrophysiological study showed findings compatible with early GBS, whereas the follow-up study on day 10 demonstrated marked progression to a widespread sensorimotor polyneuropathy. Cervicothoracic spinal magnetic resonance imaging revealed a longitudinally extensive T2-hyperintense intramedullary lesion extending from C3 to T1, consistent with LETM. Isolated anti-GD3 IgG positivity was detected, while other ganglioside antibodies, nodal/paranodal antibodies, anti-myelin oligodendrocyte glycoprotein antibodies, and paraneoplastic investigations were negative. Conclusion: This case highlights the possible association of isolated anti-GD3 IgG positivity with the rare GBS–LETM overlap syndrome. Furthermore, it emphasizes that limited early electrophysiological abnormalities do not exclude GBS and that serial electrophysiological assessment may facilitate diagnosis when concomitant spinal cord involvement is suspected.

Keywords

• Guillain–Barré Syndrome
• Transverse Myelitis
• Anti-GD3 IgG

Supporting Institution

nothing to declare

Ethical Statement

Ethics committee approval was waived because this study is a single-patient case report. Written informed consent for publication was obtained from the patient.

Thanks

Thanks to editors and reviewers

İzole Anti-GD3 IgG Pozitifliğinin Eşlik Ettiği Guillain–Barré Sendromu ve Uzun Segment Transvers Miyelit Birlikteliği

Abstract

Amaç: Guillain–Barré sendromu ile longitudinally extensive transvers miyelit birlikteliği, santral ve periferik sinir sisteminin birlikte etkilendiği nadir bir overlap sendromudur. Bu yazıda izole anti-GD3 IgG pozitifliğinin eşlik ettiği Guillain–Barré sendromu–longitudinally extensive transvers miyelit overlap olgusunun sunulması ve seri elektrofizyolojik değerlendirmenin tanısal öneminin vurgulanması amaçlandı. Metod: Yetmiş dört yaşındaki erkek hasta; 2. ve 10. günlerde yapılan seri elektrofizyolojik incelemeler, beyin omurilik sıvısı analizi, servikal-torakal spinal manyetik rezonans görüntüleme ve serum gangliozid, nodal/paranodal, anti-MOG ve paraneoplastik antikor panelleri ile değerlendirildi. Bulgular: Hastada hızla ilerleyen kuadripleji, yaygın arefleksi, T2 altında duyu seviyesi ve üriner retansiyon gelişti. Beyin omurilik sıvısında albüminositolojik disosiasyon saptandı. İlk elektrofizyolojik inceleme erken Guillain–Barré sendromu ile uyumlu bulgular gösterirken, 10. gündeki kontrol incelemesinde yaygın sensörimotor polinöropati lehine belirgin progresyon izlendi. Servikal-torakal spinal manyetik rezonans görüntülemede C3–T1 düzeyleri arasında longitudinally extensive transvers miyelit ile uyumlu T2 hiperintens intramedüller lezyon saptandı. İzole anti-GD3 IgG pozitifliği mevcutken diğer gangliozid, nodal/paranodal, anti-MOG antikorları ve paraneoplastik incelemeler negatifti. Sonuç: Bu olgu, izole anti-GD3 IgG pozitifliğinin nadir Guillain–Barré sendromu–longitudinally extensive transvers miyelit overlap fenotipi ile olası ilişkisine dikkat çekmektedir. Ayrıca erken dönemde sınırlı elektrofizyolojik bulguların Guillain–Barré sendromunu dışlamadığını ve eşlik eden spinal kord tutulumu düşünüldüğünde seri elektrofizyolojik değerlendirmenin tanıya katkı sağlayabileceğini göstermektedir

Keywords

• Guillain-Barre Sendromu
• Transvers Miyelit
• Anti-Gd3 IgG

Supporting Institution

(yok )

Ethical Statement

Tek olguluk bildiri olduğu icin etik kurula başvurulmamıştır. Hastadan bilgilendirilmiş gönüllü onam formu alınmıştır.

Thanks

Editor ve inceleyenlere teşekkürler

References

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