Pharyngeal-cervical-brachial variant of Guillain-Barre syndrome in a patient with thalassemia intermedia

Abstract

Here, we present the first instance of Guillain-Barre syndrome variant in a patient with beta thalassemia and iron overload who had a history of transfusion before the onset of symptoms. Our patient was a 50- year-old Persian woman with history of intermediate thalassemia who had been treated with pack cells because of low hemoglobin level. Ten days after transfusion, she developed numbness of arms, left sided ptosis, and afterwards dysarthria, dysphagia, and bilateral ptosis. Electrodiagnosis on day 12 revealed reduced repetition of f-waves in the upper limbs and reduced recruitment with 1+ fibrillation in facial muscles. Electromyography and nerve conduction velocities in the limbs were normal. After excluding other causes and according to electrodiagnosis, the pharyngeal-cervical-brachial variant of Guillain-Barre syndrome was considered and plasma exchange began. Following exchanges, significant clinical improvement was attained. Iron overload and possible transmission of infections from blood products might have contributed in the development of syndrome.