J Neurocrit Care.  2021 Dec;14(2):117-120. 10.18700/jnc.210011.

Flaccid quadriparesis with raised creatine kinase in Guillain-Barré syndrome: a case report with review of literature

• Mahesh B
• Pathak A
• Chaurasia RN
• Kumar A
• Singh VK

• KMID: 2523723
• DOI: http://doi.org/10.18700/jnc.210011

Abstract

Background
Guillain-Barré syndrome (GBS) is an immune-mediated inflammatory polyneuropathy characterized by acute flaccid paralysis. Elevated creatine kinase (CK) levels in GBS have been reported to be transient, and levels vary from mild to severe. Herein, we report a case of GBS with elevated CK mimicking acute myositis.
Case Report
A 48-year-old man presented with pure motor flaccid quadriparesis. Power was 2/5 with hypotonia and areflexia in all four limbs. A nerve conduction study revealed reduced compound muscle action potential in all recorded motor nerves. Serum CK was 2,334 U/L. The patient’s symptoms progressed despite intravenous methylprednisolone administration. Cerebrospinal fluid (day 8) revealed albuminocytological dissociation, and electromyography (day 21) revealed spontaneous activity with neurogenic motor unit action potential suggestive of acute motor axonal neuropathy variant of GBS.
Conclusion
In a patient with elevated CK and ascending paralysis, differential diagnosis of GBS should be considered and cerebrospinal fluid study and electromyography should aid in confirming the diagnosis.

Keyword

Guillain-Barre syndrome; Flaccid quadriparesis; Creatine Kinase; Intravenous immunoglobulin

Reference

1. Yuki N, Hartung HP. Guillain-Barré syndrome. N Engl J Med. 2012; 366:2294–304.

2. Silvestri NJ, Wolfe GI. Asymptomatic/pauci-symptomatic creatine kinase elevations (hyperckemia). Muscle Nerve. 2013; 47:805–15.

3. Chahin N, Sorenson EJ. Serum creatine kinase levels in spinobulbar muscular atrophy and amyotrophic lateral sclerosis. Muscle Nerve. 2009; 40:126–9.

4. Ropper AH, Shahani BT. Pain in Guillain-Barré syndrome. Arch Neurol. 1984; 41:511–4.

5. Scott AJ, Duncan R, Henderson L, Jamal GA, Kennedy PG. Acute rhabdomyolysis associated with atypical Guillain-Barré syndrome. Postgrad Med J. 1991; 67:73–4.

6. Hanemann CO, Neuen-Jacob E. Muscle injury in Guillain-Barré syndrome: a case report. J Neurol. 1999; 246:1207–8.

7. Satoh J, Okada K, Kishi T, Nagayama S, Kuroda Y. Cramping pain and prolonged elevation of serum creatine kinase levels in a patient with Guillain-Barré syndrome following Campylobacter jejuni enteritis. Eur J Neurol. 2000; 7:107–9.

8. Saxena A, Singh V, Verma N. Guillain-Barre syndrome complicated by acute fatal rhabdomyolysis. Indian J Crit Care Med. 2014; 18:241–3.

9. Choi SJ, Hong YH, Kim JS, Shin JY, Sung JJ. HyperCKemia in Guillain-Barré syndrome. Eur Neurol. 2020; 83:415–20.

10. Hosokawa T, Nakajima H, Sawai T, Nakamura Y, Sano E, Tsukahara A, et al. Clinical features of Guillain-Barré syndrome patients with elevated serum creatine kinase levels. BMC Neurol. 2020; 20:214.