A 24-year-old previously healthy male soldier experienced an upper respiratory tract infection (URI) 2 weeks prior to his presentation. One week after the infection subsided, he had dysphagia, truncal and limb ataxia, and symmetrical proximal muscles weakness. On the third day of his neurological illness, total ophthalmoplegia, cerebellar dysarthria, and generalized hyporeflexia were evidenced at a primary hospital, and then, he was immediately transferred to our hospital. He had never been exposed to food or substances containing neurological toxins. On admission to our center, the weakness of limbs and respiratory muscles progressed rapidly to flaccid quadriparesis, which was dominant in the upper limbs, and respiratory muscle paralysis so that mechanical ventilation was indicated. All deep tendon reflexes were absent. Nevertheless, his consciousness, pinprick sensation, and proprioception were absolutely intact. MFS and GBS overlap syndrome was a provisional diagnosis at initial evaluation. The GBS disability score at that time was 5. Medical Research Council sum score was 44; the muscle strength was symmetrical as follows: both shoulders abduction 3; elbow flexion 3; wrist extension 4; hip flexion 4; knee flexion 4, and ankle dorsiflexion 4.
The results of routine blood chemistry tests, anti-HIV, anti-HBV, anti-HCV, as well as a panel of serology tests of autoimmune disorders were unremarkable. The cerebrospinal fluid (CSF) analysis revealed clear CSF, normal pressure, and no blood cells. The CSF/serum glucose ratio was 83/110 mg/dL. CSF protein was 74.9 mg/dL. CSF culture and polymerase chain reaction for possible organisms, such as bacteria, mycobacterium tuberculosis, herpes viruses, Japanese B virus, and Dengue viruses, yielded negative results. The electroneuromyographic (ENMG) study showed symmetrical sensorimotor axonal polyneuropathy, which was dominant in both upper limbs. Left facial axonal neuropathy was detected as well (Fig. 1). A panel of AGAbs, including anti-GM1, -GM2, -GM3, -GD1a, -GD1b, -GT1b, and -GQ1b, was negative. Based on the clinical presentation and ENMG results, MFS/AMSAN-GBS overlap syndrome was the final diagnosis, and intravenous immunoglobulin (IVIG) therapy was immediately initiated. The neurological symptoms dramatically resolved 4 days after the treatment. GBS disability score became 2 eventually.