To our knowledge, 20 patients with Guillain-Barré Syndrome (GBS) secondary to acute hepatitis A virus (HAV) infection have been reported in the literature. Only one of them was a child(1). We report another such case in a 6 year old boy who presented with pain and weakness in legs and difficulty in walking. His past medical history was unremarkable except for a jaundice two weeks back. Vital signs and anthropometry was in normal limits. Neurological examination revealed reduced power (2/5) and hypotonia in all extremities. Deep tendon reflexes (DTR) were absent. Other systemic examination was normal. Transaminases (SGOT: 1000 IU/dL, SGPT: 900 IU/dL) and bilirubine levels (total/direct bilirubin: 12/10 mg/dL) were elevated. Anti-HAV Ig M was positive and anti-HAV Ig G was negative in blood and cerebrospinal fluid (CSF); markers for hepatitis B virus (HBV) were negative. Cerebrospinal fluid revealed a protein concentration of 82 mg/dL, glucose of 41 mg/dL and no cells. Electro-myograpy and nerve conduction velocity revealed a severe motor polyneuropathy associated with axonal damage in muscles and nerves in all extremities.

The patient was treated with 0.5 g/kg intravenous immunoglobulin (IVIG) for five days. He was discharged from the ward on the tenth day of admission. Physical examination at the end of the first month showed a 4/5 of the muscle power and positive DTR. Laboratory studies revealed normal liver function tests. The serum anti-HAV Ig M and anti-HAV Ig G were positive.

Guillain-Barré Syndrome occurring in the course of acute hepatitis caused by hepatotrophic viruses like cytomegalovirus (CMV), Epstein-Barr Virus (EBV), HBV and HAV have been reported previously(1-4). In patients who develop GBS after an acute viral hepatitis, demonstration of the specific viral antibodies in the CSF may confirm the central nervous system involvement(5).

Kocabas E,
Yildizdas D,
Çukurova University Faculty of Medicine,
Department of Pediatrics,
Adana/TURKEY
Correspondence:
Dr. Dinçer Yildizdas,
Çukurova University Faculty of Medicine,
Pediatric Intensive Care Unit,
01330, Adana/Turkey.
E-mail: [email protected]

1. Azuri J, Lerman-Sagie T, Mizrahi A, Buja-nouer Y. Guillain-Barre syndrome following serological evidence of hepatitis A in a child. Eur J Pediatr 1999; 158: 341-342.

2. Glaze DG. Guillain-Barré Syndrome. In: Feigin RD, Cherry JD, editors. Textbook of Pediatric Infectious Diseases 4th ed. Philadelphia: WB Saunders; 1998. p 470-482.

3. Guillain-Barre Syndrome. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics. 16th ed. Philadelphia: WB Saunders; 2000. p 1892-1893.

4. Tabor E. Guillain-Barré Syndrome and other neurologic syndromes in hepatitis A, B and non- A, non- B. J Med Virol 1987; 21: 207-216.

5. Breuer GS, Morali G, Finkelstein Y, Halevy J. A pregnant woman with Hepatitis A and Guillain-Barré Syndrome. J Clin Gastroenterol 2001; 32: 179-180.