Co-morbid Guillain-Barre syndrome and acute disseminated encephalomyelitis

Abstract

Guillain-Barre syndrome (GBS) and acute disseminated encephalomyelitis (ADEM) are clinically distinct demyelinating disorders that share an autoimmune pathogenesis and prior history of viral infection or vaccination. Concurrent GBS and ADEM are uncommon with few reported cases. Our patient is a 10-year-old girl who presented with acute quadriparesis, areflexia, and urinary retention. Lumber puncture revealed mild pleocytosis and elevated protein. She required mechanical ventilation and failed to improve after intravenous immunoglobulins. She subsequently developed double vision and disturbed level of consciousness. Brain MRI revealed multiple white matter lesions suggestive of ADEM. Based on the temporal association and exclusion of alternative etiologies, we made a diagnosis of GBS and ADEM. She improved remarkably after intravenous methylprednisolone. We conclude that co-morbid GBS and ADEM is an uncommon entity presenting with severe neurological morbidity. Prompt recognition and treatment can hasten the recovery and therefore improve the neurological outcome.