Anagi Shakya Kottahachchi ¹, Mihira Manamperi¹, Chaturi Chapa Bandara¹, Prabhahwara Kularathne ¹, Thilini Somaratne²
1- Paediatric Department, Sri Jayewardenepura General Hospital, Sri Lanka
2- Medical Research Institute, Sri Lanka
Corresponding Author:
Anagi Shakya Kottahachchi (
anagikottahachchi@gmail.com )
Abstract Body
Introduction: Guillain–Barré Syndrome (GBS) is an acute immune-mediated polyneuropathycharacterized by rapid onset muscle weakness and areflexia, often following infection by Campylobacter jejuni, Cytomegalovirus, and Epstein–Barr virus. However, arboviruses like Chikungunya are rarely associated with GBS. We are reporting a case of GBS associated with Chikungunya infection.
Case presentation: A previously healthy 6-year-old boy presented with acute onset ataxia andslurred speech since 2 hours. He had mild fever for 3 days with some respiratory symptoms. There was no history of seizures, bladder or bowel incontinence. Initial neurological examination revealed pronounced truncal ataxia with slightly diminished reflexes. Following day it hadprogressed to positive finger nose test. Lumbar puncture, MRI brain and spine and peripheral nerve conduction study were normal. He was transferred to the leading Paediatric center for further evaluation. The repeat nerve conduction study done on day 9 was compatible with GBS.Full blood count and C-reactive-protein showed a viral pattern. Serum Chikungunya IgMbecame positive and viral studies of cerebrospinal fluid were negative. He responded rapidly to intravenous immunoglobulin and methyl prednisolone.
Discussion and
Conclusion: This child’s clinical presentation is suggestive of post-infectious cerebellitis. However, the evolution f symptoms and positive repeat nerve conduction study established the diagnosis of GBS precipitated by Chikungunya infection. Repeated neurophysiological testing is valuable when initial studies are inconclusive, and timely initiation of intravenous immunoglobulin therapy offers a better outcome.