Introduction: Guillain-Barré syndrome (GBS) and acute transverse myelitis (ATM) are autoimmune diseases with differences in therapeutical approach and prognosis. However, concurrent GBS and ATM can occur in rare cases as overlap syndrome.

Methods: We describe a paediatric patient with GBS and ATM.

Results: A 2-year-old boy presented with paresis and areflexia of both lower extremities. The symptoms rapidly spread to both upper extremities, accompanied by trunk hypotonia and dysphagia. A recent respiratory infection was reported. The MRI showed a transverse myelitis at C2-C3 and C5. However, the cerebrospinal fluid (CSF) analysis revealed albuminocytologic dissociation indicating GBS. Myelin oligodendrocyte glycoprotein (MOG)-, Aquaporin-4- and ganglioside antibodies were negative. Also, virological screening was negative. The electrophysiological findings were consistent with GBS. The patient was initially treated with intravenous immunoglobulin (IVIG), which resulted in rapid clinical improvement. However, as complete restitution had not yet occurred, another cycle of IVIG and additional methylprednisolone pulse therapy were administered. Finally, the patient recovered fully.

Conclusion: GBS/ATM overlap syndrome is extremely rare. Hence, although IVIG is the first choice in GBS, additional corticosteroid therapy should be considered in concurrent ATM, especially if the clinical improvement is not sufficient.

Jena Chung
Kepler University Clinic, Johannes Kepler University
Austria

Ariane Biebl
Kepler University Clinic, Johannes Kepler University
Austria

Gudrun Gröppel
Kepler University Clinic, Johannes Kepler University
Austria