203 - Paraneoplastic Guillain-Barré Syndrome in Metastatic Urothelial Cell Carcinoma

Case Diagnosis: A 75 year-old woman with paraneoplastic Guillain-Barré Syndrome from poorly-differentiated metastatic urothelial cell carcinoma.

Case Description: Patient presented to acute care hospital from acute rehabilitation hospital where she was in therapy for approximately 1 month of progressive left lower extremity weakness and ambulatory dysfunction. While in the rehabilitation hospital, the patient's weakness progressed to her bilateral upper and lower extremities, and she became markedly hyporeflexic.

Discussions:

Guillain-Barre Syndrome (GBS) refers to a spectrum of acute inflammatory demyelinating/axonal polyneuropathies characterized by progressive, ascending symmetric weakness and loss of reflexes. GBS is thought to be secondary to autoantibody-mediated demyelination triggered by an antecedent event such as a viral or bacterial infection. 

Paraneoplastic syndromes refer broadly to antibody-mediated neurological disorders due to an immune-response to malignancy. There are reports of paraneoplastic syndromes affecting all portions of the nervous system, including those of paraneoplastic GBS. Although this condition remains controversial, there have been case reports of GBS occurring in patients with different types of cancer, including urothelial cell carcinoma. 

Diagnosis of paraneoplastic GBS has been made by correlating clinical presentation of the patient with the presence of laboratory findings such as albuminocytologic dissociation and autoantibodies associated with paraneoplastic syndromes, EMG findings indicative of demyelinating/axonal processes, as well as supportive criteria such as enhancement of cauda equina nerve roots on MRI.

Conclusions: Paraneoplastic GBS is a rare disease process that has profound effects on patient function and quality of life. While prognosis remains guarded, this case demonstrates the need for rehabilitation services in those affected.