J Korean Med Sci.  2018 Jan;33(4):e29. 10.3346/jkms.2018.33.e29.

Recurrent Guillain-Barré Syndrome Following Urinary Tract Infection by Escherichia coli

• Jo YS
• Choi JY
• Chung H
• Kim Y
• Na SJ

• KMID: 2400647
• DOI: http://doi.org/10.3346/jkms.2018.33.e29

Abstract

Recurrent Guillain-Barré syndrome (GBS) is a rare, immune-mediated disease of the peripheral nervous system. It has been reported to occur at intervals ranging from four months to 10 years; published case studies suggest that 1%-6% of patients who have had GBS will experience recurrent attacks. The most commonly identified infections coinciding with GBS are Campylobacter jejuni, Haemophilus influenzae, Mycoplasma pneumonia, and cytomegalovirus, while an antecedent infection with Escherichia coli is very uncommon. In this case report, we present a rare episode of recurrent GBS, which followed a urinary tract infection (UTI) by E. coli, and an accompanying literature review. A 75-year-old woman with a prior history of acute motor axonal neuropathy (AMAN), a subtype of GBS, presented with subsequent weakness of limbs and areflexia following 10 days of fever, frequency, and dysuria. Base on nerve conduction studies, cerebrospinal fluid analysis and other clinical investigation, we diagnosed the patient with recurrent GBS caused by E. coli. The patient recovered with mild subjective weakness following treatment of intravenous immunoglobulin with ceftriaxone. We suggest that E. coli causes UTI could be one of the diverse trigger factors involved in recurrent GBS.

Keyword

Guillain-Barré Syndrome; Polyneuropathies; Urinary Tract Infection; Uropathogenic Escherichia coli

MeSH Terms

Aged
Axons
Campylobacter jejuni
Ceftriaxone
Cerebrospinal Fluid
Cytomegalovirus
Dysuria
Escherichia coli*
Escherichia*
Extremities
Female
Fever
Guillain-Barre Syndrome*
Haemophilus influenzae
Humans
Immunoglobulins
Neural Conduction
Peripheral Nervous System
Pneumonia, Mycoplasma
Polyneuropathies
Urinary Tract Infections*
Urinary Tract*
Uropathogenic Escherichia coli
Ceftriaxone
Immunoglobulins