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02 October 2017 : Case report  Japan

Guillain-Barré Syndrome: A Variant Consisting of Facial Diplegia and Paresthesia with Left Facial Hemiplegia Associated with Antibodies to Galactocerebroside and Phosphatidic Acid

Unusual clinical course, Challenging differential diagnosis

Sho Nishiguchi1ABDEF*, Joel Branch1ADE, Tsubasa Tsuchiya1ADF, Ryoji Ito1BD, Junya Kawada2DEF

DOI: 10.12659/AJCR.904925

Am J Case Rep 2017; 18:1048-1052

Abstract

BACKGROUND: A rare variant of Guillain-Barré syndrome (GBS) consists of facial diplegia and paresthesia, but an even more rare association is with facial hemiplegia, similar to Bell’s palsy. This case report is of this rare variant of GBS that was associated with IgG antibodies to galactocerebroside and phosphatidic acid.

CASE REPORT: A 54-year-old man presented with lower left facial palsy and paresthesia of his extremities, following an upper respiratory tract infection. Physical examination confirmed lower left facial palsy and paresthesia of his extremities with hyporeflexia of his lower limbs and sensory loss of all four extremities. The differential diagnosis was between a variant of GBS and Bell’s palsy. Following initial treatment with glucocorticoids followed by intravenous immunoglobulin (IVIG), his sensory abnormalities resolved. Serum IgG antibodies to galactocerebroside and phosphatidic acid were positive in this patient, but not other antibodies to glycolipids or phospholipids were found. Five months following discharge from hospital, his left facial palsy had improved.

CONCLUSIONS: A case of a rare variant of GBS is presented with facial diplegia and paresthesia and with unilateral facial palsy. This rare variant of GBS may which may mimic Bell’s palsy. In this case, IgG antibodies to galactocerebroside and phosphatidic acid were detected.

Keywords: Bell Palsy, Facial Paralysis, Guillain-Barre Syndrome, Paresthesia, Phosphatidic Acids

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923