Background Guillain Barré Syndrome (GBS) is an acute demyelinating inflammatory acquired polyneuropathy. The disease is probably caused by a post-infectious immune mediated process that affects essentially motor neurons. Varicella-zoster virus has been rarely related to this disease. We found in the literature only 48 cases of Guillain-Barré syndrome post varicella-zoster infection.
Case Report Authors report a 3 year old child, female, admitted with lower limbs hyperesthesia and walking difficulty, which started 8 days before admission. Two weeks prior to admission there was varicella-zoster infection.
Her neurological examination showed slight reduction of proximal lower limb strength (4/5), arreflexia, gait instability and impaired joint position sense. Cerebrospinal fluid analysis showed 77 mg/dl proteins, 0.8/mm3 cels and Varicella-zoster virus PCR was negative. EMG showed reduced nerve conduction velocity. Serologies for Campilobacter jejuni, Epstein Barr virus, cytomegalovirus, human immunodeficiency virus and Mycoplasma pneumoniae were negative. Enterovirus stool culture was negative. Serum immunological tests revealed IgA 0.3 g/L, IgG 10.3 g/L, IgM 1.08 g/L, total lymphocytes 3185/mcl, CD3 74%, CD8 24%, Linfocits B CD19 19%, NK CD16+56+ 5%.
She was treated with immunoglobulin 400 mg/kg/day for 5 days and gabapentin 4 mg/kg/day. Muscular strength and motor coordination were almost recovered within 9 days. At discharge there was still arreflexia. 2 month after admission she was completely recovered.
Discussion This case shows a temporal relation between GBS and varicella-zoster infection. However clinical cases reported in the literature state a more severe course of the disease, with need for airway mechanical support and residual strength impairment that was not noted in our case.