Abstract Details

Guillain Barre Syndrome (GBS) is a syndrome in which patients develop ascending paralysis. Rare variants of Guillain Barre can present with ophthalmoplegia, facial diplegia or sixth nerve palsies. Although GBS and its variants (GBV) are presumed to be autoimmune in nature, the exact pathogenesis remains unclear. West Nile Virus (WNV) is a mosquito-borne neuroinvasive disease that results in meningitis, encephalitis and acute flaccid paralysis. On a thorough literature review, there exist no publications of signs and symptoms consistent with a variant for Guillain Barre as the presentation for West Nile Virus.

To report a case of West Nile Virus presenting as a Guillain Barre Variant.

A 79 year old male with a past medical history of hyperlipidemia, hypertension, and prediabetes presented for eight days of generalized malaise, nausea, facial diplegia, and ascending weakness in the bilateral lower extremities. The patient also endorsed significant social stressors resulting in feelings of depression, anhedonia, increased sleepiness, and decreased energy, concentration, and appetite. Physical exam, CBC, BMP, EKG and CXR were unremarkable on presentation. Ferritin was elevated. The patient then developed new dysarthria and dysphagia. CT and MRI imaging revealed an acute right PICA stroke, which did not explain the patient's initial presentation. A lumbar puncture was done and revealed albuminocytologic dissociation favoring a variant of Guillain Barre, so plasmapheresis was initiated. Later in the course, WNV antibodies were found in the cerebrospinal fluid. The patient improved with plasmapheresis and was discharged to inpatient rehabilitation.

This is a case in which West Nile Virus infection uniquely presents as a rare Guillain Barre Variant. While infections typically precede GBV, it is uncommon for the infectious source to be WNV. 

West Nile Virus should be considered when patients present with signs and symptoms consistent with GBS or GBV with a negative initial workup for infectious sources.