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Case Reports
. 2020 Jun;48(3):471-475.
doi: 10.1007/s15010-020-01397-5. Epub 2020 Mar 3.

A horse and a zebra: an atypical clinical picture including Guillain-Barré syndrome, recurrent fever and mesenteric lymphadenopathy caused by two concomitant infections

Felix Amereller  1 , Christian Lottspeich  1 , Grete Buchholz  2 , Karl Dichtl  3
Affiliations
Case Reports

A horse and a zebra: an atypical clinical picture including Guillain-Barré syndrome, recurrent fever and mesenteric lymphadenopathy caused by two concomitant infections

Felix Amereller et al. Infection. 2020 Jun.

Abstract

Background: While Campylobacter jejuni represents the most common cause of bacterial gastroenteritis, Yersinia pseudotuberculosis infections are very rarely diagnosed in adults.

Case: We report on a previously healthy patient who presented several times at our hospital with fever, Guillain-Barré syndrome, recurrent abdominal symptoms and distinct mesenteric lymphadenopathy, respectively. This complicated and diagnostically challenging course of disease was caused by a C. jejuni and Y. pseudotuberculosis coinfection. Antibiotic treatment with doxycycline was effective.

Conclusion: Broad serology testing was crucial to discover that two concomitant infections were causing the symptoms. This case demonstrates that when a clinical picture is not fully explained by one known infection, another infection with the same underlying risk factor has to be considered, hence "a horse and a zebra".

Keywords: Campylobacter jejuni; Guillain-Barré syndrome; Mesenteric lymphadenitis; Mesenteric lymphadenopathy; Pseudoappendicitis; Yersinia pseudotuberculosis.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Abdominal ultrasound examination reveals multiple enlarged mesenteric lymph nodes in the right lower quadrant. a Hypoechoic lymph nodes surrounded by hyperechoic mesenteric tissue. b Diameters of the two largest oval shaped lymph nodes (max. diameter 4 cm). c Hilus perfusion of the lymph nodes depicted by duplex ultrasound
See this image and copyright information in PMC

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