Simultaneous Occurrence of Myelitis and Guillain-Barré Syndrome (GBS) Caused by Mycoplasma Pneumoniae with Positive Outcome

Background: Infection with Mycoplasma pneumoniae causes peripheral or central inflammatory demyelinating disease. Simultaneous affection of peripheral and central nervous system has been described only in few case reports. Early diagnosis seems to be difficult, frequency of occurrence might be underestimated.

Methods: We report the clinical findings, magnetic resonance imaging (MRI) and electrophysiological tests in a 12-year-old boy with coexistence of transverse myelitis and GBS.

Results: The patient presented with nonascending weakness of the extremities and distal paresthesia. MRI revealed increased signals in the cervicothoracic spinal cord on T2-weighted series without gadolinium enrichment. CSF analysis showed 81 /3 cells and elevated protein (54.8 mg/dL). Paralysis, sensitivity disorder and pleocytosis could be explained by transverse myelitis. Throat swab (PCR) and serological work-up showed positive results for Mycoplasma pneumoniae. Nerve conduction studies (NCS) disclosed lesions in the pyramidal tract supplying the left leg and arm as well as pathological A-Waves as a sign of peripheral demyelinating disease. After one week MRI revealed thickened fibers of the cauda equina with gadolinium enrichment. NCS showed absent F-Waves. An Overlap syndrome with coexistence of transverse myelitis and GBS triggered by Mycoplasma pneumoniae was confirmed. The patient was treated with doxycycline and recovered completely without immunological therapy.

Conclusion: This case report points out the importance of repeated electrophysiological studies in acute flaccid paralysis. Follow-up MRI, CSF and electrophysiology are necessary to show the simultaneous occurrence of myelitis and GBS. Early diagnosis is important for treatment and prognosis. The outcome can be good.