Only anti-GM4 antibody positivity in a Chinese girl with overlapping MFS/GBS: a case report

Abstract

Background: Guillain-Barré syndrome (GBS), as the most common cause of acute flaccid paralysis worldwide, is considered a part of a clinical spectrum in which discrete, complete, or incomplete forms of GBS and overlapping syndromes lie on the basis of their clinical features. The term overlapping Miller Fisher syndrome (MFS)/GBS is used when patients with MFS also suffer from progressive motor weakness of the limbs. Anti-ganglioside GQ1b has been specifically associated with MFS and ophthalmoplegia.

Case description: Here, we report a Chinese girl who was diagnosed with overlapping MFS/GBS showing acute flaccid paralysis of all four limbs, sensory symptoms, cranial nerve dysfunction, autonomic involvement, ophthalmoplegia, and ataxia. She had high serum and cerebrospinal fluid titres of monospecific anti-GM4 IgG antibody instead of anti-GQ1b antibody in the acute phase.

Conclusion: Anti-GM4 antibodies usually coexist with other antiganglioside antibodies, leading to missed diagnoses. The findings of the present study show that antibodies to ganglioside GM4 may in overlapping MFS/GBS as the lone immunological factors.

Keywords: Anti-GM4 antibodies; Guillain-Barré syndrome; Miller-Fisher syndrome; Overlapping MFS/GBS.

Fig. 1

Nerve conduction studies of the patient. The absence of compound muscle action potentials (CMAP) in right the facial nerve, the amplitude of the distal CMAPs was obviously decayed in the left facial nerve (A); the bilateral tibial and common fibular nerves, the CMAP amplitude was reduced and the motor nerve conduction velocity (m-NCV) was slowed (B, C); sensory nerve action potentials (SNAPs) could not be detected in the common fibular nerve (D)