神経感染症

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Guillain Barre Syndrome Associated with Brucellosis: A Case Report and Review of the Literature

Daoud S*, Farhat N, Kacem HH, Hdiji O, Sakka S, Damak M and Mhir C

Introduction: Guillain-Barré syndrome (GBS) ranks as the most frequent cause of acute flaccid paralysis in the world. It is an autoimmune polyradiculoneuropathy, usually preceded by an acute infection. Rarely, brucellosis may induce a GBS.
Objective: To evaluate the clinical and microbiological diagnostic properties of Brucella-induced GBS.
Case Report: A 54-year-old woman, with no past medical history, was followed in infectious disease department. She was diagnosed with brucellosis. She had received antibiotic therapy (Rifampicin 600 mg/day and Doxycycline 200 mg/day). After 4 days of treatment, she was referred to our department because of rapidly progressive, ascending, symmetric weakness and bilateral paralysis of muscles of the face. On admission, she was alert. The deep tendon reflexes (DTRs) were absent in all extremities. Muscle strength was 3/5 in the upper extremities and 2/5 in the lower extremities. Proprioception in the lower extremities was impaired, but she did not have any sensory problems. Our patient also presented a facial diplegia. Physical examination was normal, except for splenomegaly. A lumbar puncture showed an albumin-cytologic dissociation in the CSF. Nerve-conduction studies were suggestive of demyelinating polyradiculoneuropathy. Coombs Wright titration was 1/160..
Discussion: With a diagnosis GBS preceded by brucellosis, our patient was given an antibiotic therapy (Rifampicin 600 mg/day and Doxycycline 200 mg/day). During hospitalization, she had four plasma exchange sessions and a motor rehabilitation. In a follow-up after 4 weeks, our patient presented a partial recovery, and she was able to walk without support.
Conclusion: This case demonstrates that brucellosis can present with a rare neurologic manifestation including GBS. Molecular mimicry seems to be responsible for this complication, through the synthesis of autoantibodies against myelin gangliosides. Thus, brucellosis should be ruled out in all patients who develop acute flaccid paralysis, especially in those who live in endemic areas.