Guillain barré syndrome of axonal type in a multple sclerosis patient: Fortuitous association or linked disorders?

A Guillain Barré syndrome is a rare event in the course of MS, in spite of the fact that both disorders are demyelinating and are possibly immune mediated. We present a case of a 45-years-old female with a definite MS of the RR type clinically characterized by an ataxic paraparesis who presented a subacute worsening of the muscolar strenght in the legs and, within few days, in the upper limbs. At admission the patient was feverish, almost paraplegic, mentation was lowered and she appeared drowsy. A spinal tap was performed showing a dramatic increase of the proteins without cellular increase. At neurophysiological study signs of denervation, with absence of the sensory evoked potentials in the sural nerves, were detected. At sural nerve biopsy a marked decrease of myelinated fibers in all the fascicles, with many fibers in active axonal degeneration, was observed. The patient was treated with high J< ->age Ig e.v. with slow improvement of clinical conditions. This remarkable case suggests that in the course of MS the epitope spreading phenomenon might unfrequently involve antigens shared by PNS and CNS.