Guillain-Barre syndrome: a typical paraneoplastic syndrome in a kidney transplant recipient with allograft renal cell ca
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CASE REPORT
Open Access
Guillain-Barre syndrome: a typical paraneoplastic syndrome in a kidney transplant recipient with allograft renal cell carcinoma: a case report and review of the literature Izabela Zakrocka1* , Iwona Baranowicz-Gąszczyk1, Agnieszka Korolczuk2 and Wojciech Załuska1
Abstract Background: Guillain-Barré syndrome (GBS) is an autoimmune polyneuropathy affecting the peripheral nervous system. This neurological disorder has been previously reported in bone marrow transplant recipients but is uncommon after kidney transplantation. Viral infections and calcineurin inhibitors are the main triggers of GBS in renal transplant recipients. Case presentation: In this report, we present a case of a 47-year-old male patient 12 years after his second kidney transplantation who developed GBS due to papillary renal cell carcinoma. Infectious and drug-related origins of GBS were excluded. Despite intensive treatment, graftectomy was performed, after which neurological symptoms resolved. Conclusions: In kidney transplant recipients, paraneoplastic aetiology should be considered in the differential diagnosis of GBS. Keywords: Guillain-Barré syndrome, Kidney, Kidney transplantation, Papillary renal cell carcinoma
Background Neurological complications remain one of the biggest challenges among patients after solid organ transplantation. It is estimated that nervous system dysfunction occurs in 9 out of 10 transplanted patients but is often not reported [1]. Among symptoms experienced by renal transplant recipients, those connected with peripheral nerve damage are scarce. Guillain-Barré syndrome (GBS) is the most common acute ascending polyneuropathy in adults, affecting 0.5–2 per 100,000 people per year [2]. * Correspondence: [email protected] 1 Department of Nephrology, Medical University, Jaczewskiego street 8, 20-090 Lublin, Poland Full list of author information is available at the end of the article
The majority of reported cases after transplantation are composed of men with symptoms occurring from 2 days to 10 years after graft implantation. Unlike bone marrow transplant recipients, GBS in solid organ transplant patients is less often diagnosed. GBS after transplantation is predominantly linked with infections caused by cytomegalovirus (CMV) [3], Epstein-Barr virus (EBV) [4], Campylobacter jejuni and calcineurin inhibitors [2]. The paraneoplastic aetiology of peripheral polyneuropathy due to renal cell carcinoma [5, 6] or its treatment [7] was previously reported but not in renal transplant recipients.
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