Kemal Balcı, Çetin Kürşad Akpınar, Hakan Doğru

Diyabetik Ketoasidozla İlişkili Olası Bir Guillain-Barré Sendromu: Olgu Sunumu ve Literatürün Gözden Geçirilmesi

Guillain Barre Sendromu (GBS) akut inflamatuvar bir poliradikülonöropatidir. Diyabetik ketoasidozis (DKA) ciddi, hayatı tehdit edici tip 1 diyabetes mellitusun (DM) komplikasyonudur. Guillain Barre sendromu ve diyabetik ketoasidozus patogenezinde otoimmunite rol alır. Otuzbeş yaşında erkek hasta diyabetik ketoasidoz tanısıyla endokrinoloji servisinde izlenmekte iken yatışının 7. gününde kol ve bacaklarında güçsüzlük yakınması gelişti. Tip 1 diyabetes mellitus dışında bilinen bir hastalığı yoktu. Nörolojik muayene, beyin omurilik sıvısı ve elektrofizyolojik bulgular ile Guillain-Barré Sendromu tanısı konuldu. İntravenöz immunglobulin tedavisi ile klinikte düzelme izlendi. Olgumuz da DKA’un tetiklediği GBS düşünülmüştür. Guillain Barre sendromu risk faktörü olarak diyabetes mellitus veya DKA’u işaret eden bir çalışma yoktur. Literatürde çok az sayıda olgumuza benzer vaka sunumları vardır.

A Possible Guillain-Barre Syndrome Associated with Diabetic Ketoacidosis: A Case Report and Literature Review

Guillain-Barre Syndrome (GBS) is an acute inflammatory polyradiculoneuropathy.Diabetic ketoacidosis (DKA) is a serious, life-threatening complication of Type 1diabetes mellitus (DM). In the pathogenesis of Guillain-Barre Syndrome and DKA,autoimmunity plays a role. A thirty-five year old male patient, who had beenfollowed up in endocrinology service with a diagnosis of diabetic ketoacidosis(DKA), complained of weakness in the arms and legs on the seventh day ofhospitalization. The patient had no diseases except for diabetes mellitus type 1.The patient was diagnosed with Guillain Barre Syndrome (GBS) on the basis ofneurological examination, cerebrospinal fluid results and electrophysiologicalfindings. Clinical improvement was observed as a result of intravenousimmunoglobulin therapy. Diabetic ketoacidosis induced GBS was considered forthe patient. There is no study that points to diabetes mellitus or DKA as risk factorsfor GBS. Case reports of Guillain Barre Syndrome associated with diabeticketoacidosis are rare in the literature.

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1. Asbury A, Cornblath DR. Assesment of current diagnostic criteria for Guillain-Barre Syndrome. Ann Neurol 1990;27(l):21-4.
2. Menkes HJ. Immunologically mediated demyelinating diseases of the periferal nervous system, Guillain-Barre Syndrome. In: Menkes HJ, Sarnat BH eds. Textbook of Child Neurology. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 658-65.
3. Baker DJ, Drash AL, Escobar O. Diabetic Ketoacidosis. In: Fima Lifshitz (ed). Pediatric Endocrinology. Fourth Edition. New York: Marcel Deccer Inc. 2003. p. 669-82.
4. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TPA, et al. ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents. Arch Dis Child 2004;89:88-194.
5. Yuki N, Ang CW, Koga M, Jacobs BC, van Doorn PA, Hirata K, et al. Clinical features and response to treatment in Guillain-Barre Syndrome assosiated with antibodies to GM1b ganglioside Ann Neurol 2000;47:314-21.
6. Bonfanti R, Bognetti E, Meschi F, Medaglini S, D'Angelo A, Chiumello G. Disseminated intravascular coagulation and severe peripheral neuropathy complicating ketoacidosis in a newly diagnosed diabetic child. Acta Diabetol 1994;31:173-4.
7. Lopez Messa JB, Garcia A. Acute polyneuropathy in critically ill patients. Intensive Care Med 1990;16:159-62.
8. Dhand UK. Clinical approach to the weak patient in the intensive care unit. Respir Care 2006;51:1024-40. 9. Ropper AH. The Guillain-Barre syndrome. N Engl J Med 1992;326:1130-6.
10. Foster SJ, Long TMW.Difficulty in weaning from mechanical ventilation: an unusual presentation of the Guillain-Barre syndrome. Clin Intensive Care 1992;3:30- 2.
11. Noviello TB, Noviello TC, Purisch S, Lamounier RN, Reis JS, Menezes PA, et al. Diabetes ketoacidosis associated with Guillan-Barre syndrome. Arq Bras Endocrinol Metabol 2008;52:562-5.
12. Fujiwara S, Oshika H, Motoki K, Kubo K, Ryujin Y, Shinozaki M, et al. Diabetic ketoacidosis associated with Guillain-Barre syndrome with autonomic dysfunction. Nippon Naika Gakkai Zasshi 2000;89(7):1398-414.
13. Rouanet-Larriviere M, Vital C, Arne P, Favarel-Garrigues JC, Gin H, Vital A. Guillain-Barre syndrome occurring in two women after ketoacidosic comatose state disclosing an insulin-dependent diabetes mellitus. J Peripher Nerv Syst 2000;5:27-31.
14. Kanemasa Y, Hamamoto Y, Iwasaki Y, Kawasaki Y, Honjo S, Ikeda H, et al. A case of diabetic ketoacidosis associated with Guillain-Barré syndrome. Intern Med 2011;50(19):2201-5.
15. Ertekin C. Diyabetik Nöropatiler, Santral ve Periferik EMG Anatomi-Fizyoloji- Klinik, Türkiye 2006:211-28.
16. Dumitru D, Amato A. Acquired Neuropathies. Electrodiagnostic Medicine, Inc/Philadelphia. Henley&Belfus 2002 Chapter 23:937-1019.
17. Barohn RJ, Kissel JT, Warmolts JR, Mendell JR. Chronic inflammatory demyelinating polyradiculoneuropathy. Clinical characteristics, course, and recommendations for diagnostic criteria. Arch Neurol 1989;46(8):878-84.