218 - Rapid Neurorehabilitative Recovery in Lyme-Associated AMSAN Guillain-Barré

Case Diagnosis: Acute motor and sensory neuropathy (AMSAN) variant of Guillain-Barré syndrome precipitated by Lyme neuroborreliosis

Case Description: A 19-year-old previously healthy male experienced an undocumented febrile illness (Day 1), followed by mild lower extremity paresthesia (Day 25) and rapid-onset bilateral facial diplegia with dysarthria, central tongue numbness, and distal sensory changes on Day 32. On admission (Days 33–35), examination revealed bilateral facial nerve palsy (left > right), mild symmetric lower limb weakness (4/5 hip flexion, knee extension), absent ankle reflexes, diminished pinprick/vibration in V1–V3 and foot‐sole distributions, and autonomic dysregulation (BP 113/66–152/92 mmHg; HR 41–152 bpm). CSF showed albuminocytologic dissociation (protein 85 mg/dL; 2 cells/μL), EMG/NCS confirmed demyelinating neuropathy, Lyme IgM was positive, and MRI brain/spine was unremarkable. Management included IVIG (0.4 g/kg × 5 days), five plasma exchange sessions, high-dose methylprednisolone (1 g/day × 5 days), and doxycycline for 21 days. Early in-hospital PT/OT consultations provided mobility and ADL support, followed by transfer to a specialized inpatient neurorehabilitation unit offering multidisciplinary physical, occupational, and speech therapies.

Discussions: This case underscores the diagnostic challenge and broad phenotypic spectrum of Lyme-associated AMSAN, marked by predominant cranial neuropathy and significant autonomic dysregulation. Unlike typical post-Lyme GBS reports, our patient required a tailored, aggressive immunomodulatory and antimicrobial regimen. Early integration of PT/OT and specialized neurorehabilitation likely accelerated functional recovery and restoration of independence. Recognition of this variant is critical to prompt initiation of combined therapies.

Conclusions: Clinicians should maintain a high index of suspicion for AMSAN in Lyme neuroborreliosis presenting with cranial and autonomic features. A coordinated approach—incorporating immunotherapy, targeted antibiotics, and early neurorehabilitation—can achieve favorable neurological and functional outcomes in this rare GBS subtype.