Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

A Case of Visceral Autonomic Neuropathy Complicated by Guillain-Barre Syndrome Accompanied with Cyclic Vomiting Syndrome-like Disorder in a Child

  • Hong, Suk Jin (Department of Pediatrics, Catholic University of Daegu School of Medicine) ;
  • Choe, Byung-Ho (Department of Pediatrics, Kyungpook National University School of Medicine)
  • Received : 2015.05.29
  • Accepted : 2015.06.11
  • Published : 2015.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

We present a case of an 8-year-old boy with visceral autonomic neuropathy complicated by Guillain-Barre syndrome. In this pediatric patient, gastroparesis was the major symptom among the autonomic symptoms. Due to the gastroparesis, there was no progress with the oral diet, and nutrition was therefore supplied through a nasojejunal tube and gastrojejunal tube via Percutaneous endoscopic gastrostomy (PEG). After tube feeding for 9 months, the patient's gastrointestinal symptoms improved and his oral ingestion increased. The pediatric patient was maintained well without gastrointestinal symptoms for 3 months after removal of the PEG, had repeated vomiting episodes which lead to the suspicion of cyclic vomiting syndrome. Then he started treatment with low-dose amitriptyline, which resulted in improvement. Currently, the patient has been maintained well for 6 months without recurrence, and his present growth status is normal.

Keywords

References

  1. van Doorn PA, Ruts L, Jacobs BC. Clinical features, pathogenesis, and treatment of Guillain-Barre syndrome. Lancet Neurol 2008;7:939-50. https://doi.org/10.1016/S1474-4422(08)70215-1
  2. Moulin DE, Hagen N, Feasby TE, Amireh R, Hahn A. Pain in Guillain-Barre syndrome. Neurology 1997;48:328-31. https://doi.org/10.1212/WNL.48.2.328
  3. Asahina M, Kuwabara S, Suzuki A, Hattori T. Autonomic function in demyelinating and axonal subtypes of Guillain-Barre syndrome. Acta Neurol Scand 2002;105:44-50. https://doi.org/10.1034/j.1600-0404.2002.00099.x
  4. Hasser EM, Moffitt JA. Regulation of sympathetic nervous system function after cardiovascular deconditioning. Ann N Y Acad Sci 2001;940:454-68.
  5. Kloesel B, Hickson LJ. Severe hyponatremia as the initial sign preceding guillain-barre syndrome, an acute inflammatory demyelinating polyneuropathy: a case report. Case Rep Neurol Med 2013;2013:923602.
  6. Saifudheen K, Jose J, Gafoor VA, Musthafa M. Guillain-Barre syndrome and SIADH. Neurology 2011;76:701-4. https://doi.org/10.1212/WNL.0b013e31820d8b40
  7. Hoffmann O, Reuter U, Schielke E, Weber JR. SIADH as the first symptom of Guillain-Barre syndrome. Neurology 1999;53:1365.
  8. Ramanathan S, McMeniman J, Cabela R, Holmes-Walker DJ, Fung VS. SIADH and dysautonomia as the initial presentation of Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry 2012;83:344-5. https://doi.org/10.1136/jnnp.2010.233767
  9. Singh NK, Jaiswal AK, Misra S, Srivastava PK. Assessment of autonomic dysfunction in Guillain-Barre syndrome and its prognostic implications. Acta Neurol Scand 1987;75:101-5. https://doi.org/10.1111/j.1600-0404.1987.tb07902.x
  10. Burns TM, Lawn ND, Low PA, Camilleri M, Wijdicks EF. Adynamic ileus in severe Guillain-Barre syndrome. Muscle Nerve 2001;24:963-5. https://doi.org/10.1002/mus.1095
  11. Asbury AK, Arnason BG, Adams RD. The inflammatory lesion in idiopathic polyneuritis. Its role in pathogenesis. Medicine (Baltimore) 1969;48:173-215.
  12. de Jager AE, Sluiter HJ. Clinical signs in severe Guillain-Barre syndrome: analysis of 63 patients. J Neurol Sci 1991;104:143-50. https://doi.org/10.1016/0022-510X(91)90303-O
  13. Flachenecker P, Wermuth P, Hartung HP, Reiners K. Quantitative assessment of cardiovascular autonomic function in Guillain-Barre syndrome. Ann Neurol 1997;42:171-9. https://doi.org/10.1002/ana.410420207
  14. Dimario FJ Jr, Edwards C. Autonomic dysfunction in childhood Guillain-Barre syndrome. J Child Neurol 2012;27:581-6. https://doi.org/10.1177/0883073811420872
  15. Hund EF, Borel CO, Cornblath DR, Hanley DF, McKhann GM. Intensive management and treatment of severe Guillain-Barre syndrome. Crit Care Med 1993;21:433-46. https://doi.org/10.1097/00003246-199303000-00023
  16. Drossman DA. Rome III: the new criteria. Chin J Dig Dis 2006;7:181-5. https://doi.org/10.1111/j.1443-9573.2006.00265.x
  17. Turchetti A, Guglielmi S, Fossati C, Matrunola M, Corrado G. Gastric emptying time in cyclic vomiting syndrome in children. Eur Rev Med Pharmacol Sci 2004;8:295-8.
  18. Sim YJ, Kim JM, Kwon S, Choe BH. Clinical experience with amitriptyline for management of children with cyclic vomiting syndrome. Korean J Pediatr 2009;52:538-43. https://doi.org/10.3345/kjp.2009.52.5.538
  19. Prakash C, Clouse RE. Cyclic vomiting syndrome in adults: clinical features and response to tricyclic antidepressants. Am J Gastroenterol 1999;94:2855-60. https://doi.org/10.1111/j.1572-0241.1999.01428.x
  20. Yang HR, Ko JS, Seo JK. A study on the disease course and prognosis of cyclic vomiting syndrome. J Korean Pediatr Soc 2001;44:1141-56.

Cited by

  1. A Child with Guillain-Barré Syndrome Presenting Paralytic Ileus vol.25, pp.3, 2015, https://doi.org/10.26815/jkcns.2017.25.3.191
  2. Area postrema syndrome as frequent feature of Bickerstaff brainstem encephalitis vol.5, pp.12, 2015, https://doi.org/10.1002/acn3.666
  3. Gastrointestinal dysfunction in neuroinflammatory diseases: Multiple sclerosis, neuromyelitis optica, acute autonomic ganglionopathy and related conditions vol.232, pp.None, 2015, https://doi.org/10.1016/j.autneu.2021.102795