Guillain–Barré syndrome (GBS) is widely perceived in the medical community as an autoimmune, monophasic ascending polyneuropathy with a fairly limited set of core clinical features and very similar and predictable course in the vast majority of patients. Facial diplegia and taste disturbances are extremely rare findings in GBS. Moreover, cases with predominantly sensory findings and late appearance of muscle weakness are relatively. Here we describe a case presenting with facial diplegia and paresthesias and dysgeusia as the initial presenting symptom and a review of the literature. A 30‐year‐old healthy white woman with a recent history of upper respiratory tract infection and gastrointestinal illness presented to the emergency department with complaints of numbness and tingling sensation in both hands and feet that gradually progressed to the lower back and face. Neurological examination showed left‐sided facial nerve palsy, mild ataxia, and dysgeusia. The rest of the neurological examination including strength and deep tendon reflexes and cranial nerves I–IV, VI, and VIII–XII was normal. Cerebrospinal fluid testing for a barrage of tests was essentially normal except for albumino‐cytologic dissociation. A comprehensive workup was negative for any infectious, autoimmune, metabolic, or neuromuscular etiology. Magnetic resonance imaging of the brain was unremarkable. Subsequent clinical neurophysiological study findings were consistent with early acute neuropathy suggestive of GBS, at which point the patient was started on intravenous immunoglobulin therapy. Over the next 3–6 days, the patient developed bilateral facial nerve palsy along with bilateral progressive limb weakness and difficulty walking. She was managed conservatively after this, and her weakness gradually plateaued at around 6 weeks, with near‐complete recovery at the 5‐month follow‐up.
This case underscores the marked variability of the presenting feature of GBS variants. A comprehensive review of the literature showed only a limited number of cases of GBS with facial diplegia, paresthesias, and dysgeusia. Ropper et al. were the first to describe 4 cases of GBS variant with paucity of motor neuropathy changes, which they called “facial diplegia and paresthesias” (FDP). Similarly, dysgeusia at presentation is an extremely rare finding in GBS patients. Three studies evaluating 100, 169, and 457 neuroimmunology database patients reported taste loss as an initial presentation in only 5 patients. The above‐mentioned studies also showed that the incidence of dysgeusia is much higher in FDP patients along with the late appearance of tetraplegia and areflexia, as witnessed in the case we have described.
Many of the unusual manifestations of GBS may be confused with other emergent and nonemergent conditions, often leading to frequent diagnostic dilemma and delaying diagnosis and treatment. Clinicians should be aware of these unusual signs and symptoms so that a timely diagnosis and potentially lifesaving therapy can be initiated in time.
V. Singh ‐ none; J. Kumar ‐ none; R. E. Cranston ‐ none
To cite this abstract:Singh V, Kumar J, Cranston R. Dysgeusia, Facial Diplegia, and Paresthesias—a Rare Variant of Guillain–´ Barre Syndrome. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 400. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/dysgeusia-facial-diplegia-and-paresthesiasa-rare-variant-of-guillain-barre-syndrome/. Accessed March 29, 2020.