Psoriasis and Guillain-Barre Syndrome: Incidental or Associated?
A 66-year-old male patient presented to the emergency department with complaints of numbness, tingling, and weakness in his legs since last two hours. The patient had a history of chronic plaque psoriasis affecting the lower limbs (Figure 1). On neurological examination, his dorsiflexor strength of right ankle was 4/5 and eversion strength of left ankle was 3/5. His vibratory sense was decreased on lumbar 3 and 4 dermatomes in left lower extremity. Deep tendon reflexes were normal on upper extremities; but patella reflexes were decreased in the lower extremities. The patient's laboratory studies did not reveal any infectious process. His cerebrospinal fluid studies revealed protein count of 35.8 mg/dL and glucose of 60 mg/dL with normal cell count. Cerebrospinal fluid cultures were sterile. Nerve conduction studies of the patient reported early stage acute inflammatory demyelinating polyneuropathy (Table 1). He fulfilled the Brighton criteria for GBS. (3) After GBS diagnosis, therapy with intravenous human immunoglobulin was instituted in addition to methotrexate (15 mg/week), folic acid (5 mg/week), and pregabalin (600 mg/day). He recovered gradually over the next three weeks gaining a muscle power of 5 in lower limbs. He showed significant improvement functionally and became able to walk independently. He was discharged from the hospital and the patient was called for a control visit two weeks later.
Neurologic disorders of psoriasis are rare manifestations. (4-6) To our knowledge, this is the first psoriasis patient presenting with GBS. When neurologic dysfunctions develop in patients with psoriasis history, the possibility of GBS should be kept in mind and the patients should be examined in this respect.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
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Betul SARGIN, Gulcan GURER
Department of Physical Medicine and Rehabilitation, Medical Faculty of Adnan Menderes University, Aydin, Turkey
Received: November 24, 2016 Accepted: December 05, 2016 Published online: April 11, 2017
Correspondence: Betul Sargin, MD. Adnan Menderes Universitesi Tip Fakultesi Fiziksel Tip ve Rehabilitasyon Anabilim Dali, 09010 Aydin, Turkey. Tel: +90 554-592 94 30 e-mail: email@example.com
Caption: Figure 1. Chronic plaque psoriasis affecting the lower limbs.
Table 1. Nerve conduction study Anatomic site Amplitude Latency Conduction (mV) (ms) velocity (m/sec) Right median motor Wrist 11.2 2.6 52.3 Elbow 8.9 7.0 Right ulnar motor Wrist 19.8 1.50 Elbow 19.1 6.2 Axilla 18.6 7.3 Erb's point 14.9 10.4 Right tibial motor Ankle 6.5 7.6 32.0 Knee 4.3 17.9 Left tibial motor Ankle 1.6 4.4 35.1 Knee 0.4 15.8 Left peroneal motor Ankle 4.5 4.2 36.1 Knee 4.5 12.5 62.5 Left sural sensory Ankle 4.0 3.2 41.9 Calf 3.7 3.1
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|Author:||Sargin, Betul; Gurer, Gulcan|
|Publication:||Turkish Journal of Rheumatology|
|Article Type:||Letter to the editor|
|Date:||Sep 1, 2017|
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