Guillain-Barré syndrome as first presentation of systemic lupus erythematosus: a rare manifestation complicated by IVIg-induced splenic infarct

Abstract

A 44-year-old woman presented with progressively worsening neurological symptoms of 1 week duration. Physical examination revealed absent reflexes of the lower extremities and proximal muscle weakness, bilaterally. Cerebrospinal fluid analysis and electrophysiological studies were consistent with the diagnosis of Guillain-Barré syndrome (GBS) and the patient was started on intravenous immunoglobulin infusion. Along with positive neurological findings, rheumatological work up revealed elevated antinuclear antibody titres, positive double-stranded DNA and anti-Smith antibodies. These results, in conjunction with positive clinical findings, confirmed an underlying diagnosis of systemic lupus erythematosus (SLE). The patient's hospital course was complicated by an episode of severe left upper quadrant abdominal pain, fever, tachycardia and elevated inflammatory markers. CT scan of the abdomen revealed a splenic infarct following completion of IVIg infusion, making this a contributor to thrombus formation in the setting of an already thrombophilic state, and a rare complication of an approved method of treatment.