P3396 - Anti-GQ1b Syndrome Induced by EPEC Gastroenteritis: A Rare Case Report

Mary Ayad, MD, Adewale Ajumobi, MD, FACG
Eisenhower Health, Rancho Mirage, CA

Introduction: Guillain-Barré syndrome (GBS) is a rare autoimmune disorder triggered by an immune response to an antecedent infection or other event cross-reacts with shared epitopes on peripheral nerves. Campylobacter jejuni, Haemophilus influenzae, Mycoplasma pneumonia, Epstein-Barr virus, cytomegalovirus, Zika virus, influenza virus have been linked to GBS but rarely Escherichia coli. We present a unique instance of a GBS variant induced by enteropathogenic E.coli (EPEC) gastroenteritis.

Case Description/Methods: A 63 year old man with no known medical history, presented to the ED a couple of hours after developing right upper and lower extremity weakness and numbness. He reported a self limiting episode of diarrhea prior to presentation. Stroke workup was unremarkable. Weakness and numbness progressed to his left upper and lower extremities. Later, he developed hoarseness, dysphagia, shortness of breath, respiratory failure and shock. GI panel was positive for EPEC. Due to the high clinical suspicion for GBS, the patient was started on intravenous immunoglobulin (IVIG). Cerebrospinal fluid (CSF) studies did not show albuminocytologic dissociation. GQ1b Ab IgG,GM-1 Ab (IgG),Asialo-GM-1 Ab (IgG) were moderately elevated. Paraneoplastic antibody evaluation including NMDA receptor antibodies, Acetylcholine Rec Bind Ab were unremarkable.

Discussion: Initial presentation of unilateral upper and lower extremity weakness and numbness, which later progressed to the other side followed by ascending paralysis is atypical for GBS. The development of hoarseness, dysphagia, shortness of breath, and the need for intubation indicates cranial nerve and respiratory muscle involvement. These symptoms can occur in specific variants of GBS, such as the pharyngeal-cervical-brachial weakness variant. Positive GQ1b antibody levels suggest the possibility of a variant of GBS, such as Miller Fisher syndrome. However, the absence of ocular muscle involvement is less typical for this syndrome. In this case, we propose an overlapping condition with Acute Motor and Sensory Neuropathy (AMSAN) along with pharyngeal-cervical-brachial weakness variant of GQ-1 syndrome. Extensive workup was conducted, which didn't support an alternate diagnosis. The temporal relationship between gastroenteritis and the onset of neurological symptoms, point towards this as the most reasonable cause.


Disclosures:


Mary Ayad, MD, Adewale Ajumobi, MD, FACG. P3396 - Anti-GQ1b Syndrome Induced by EPEC Gastroenteritis: A Rare Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.