Fowzia Siddiqui
Aga Khan University Hospital, Pakistan
Title: A case of GBS or Myasthenia Gravis? A diagnostic and therapeutic dilemma
Biography
Biography: Fowzia Siddiqui
Abstract
Myasthenia gravis (MG) is an autoimmune disorder characterized by weakness in specific muscle groups, especially the ocular and bulbar muscles. It is caused by antibodies directed towards the acetyl choline receptors. Guillain-Barre syndrome (GBS) presents with ascending paralysis and are flexia, often secondary to a post infectious process GBS also has a variant that can present with bulbar paresis. Several theories have been given regarding the etiology of GBS, with many studies pointing to a possible autoimmune cause. Theoretically it is also possible that the two diseases may co-exist. We presented an unusual case of a 55 year old patient with no significant past medical history, presenting with acute bulbar palsy, ophthalmoplegia and facial diplegia with respiratory distress. The patient deteriorated very rapidly. All imaging studies were normal. CSF studies too were normal. Although the diagnosis of MG was made by the positive anticholinesterase antibodies the Nerve conduction Studies (NCS) did not support MG instead showed a demyelinating pattern suggestive of GBS. The patient was treated with IVIG followed by methylprednisolone resulting in gradual improvement in symptoms. Though the co-occurrence of these two diseases has been reported rarely, no case ever showed positive acetylcholine receptor antibody in patients with GBS or its variants. So this case is unique in its presentation and a diagnostic dilemma. Did the patient have underlying MG (asymptomatic) and developed GBS or was it an underlying auto-immune process that affected both the myelinated nerve fibers and acetylcholine receptors?
