Concurrent acute motor and sensory axonal neuropathy and immune thrombocytopenic purpura

Guillain-Barré syndrome (GBS) is a potentially life-threatening autoimmune disease causing demyelination of peripheral nerves. Multiple variants of GBS exist, with acute motor and sensory axonal neuropathy (AMSAN) being the most severe. GBS typically does not occur in the setting of other autoimmune diseases; however, few case reports do exist describing the occurrence. We describe a patient with acute motor and sensory deficits and thrombocytopenia, ultimately diagnosed with concurrent AMSAN and immune thrombocytopenic purpura (ITP). A 75-year-old woman presented with new onset diplopia and gait instability, however, was found to have a severe thrombocytopenia. Corticosteroids were initiated for ITP and intravenous immunoglobulin for apparent GBS. Nerve conduction studies and her clinical course indicated that she likely had AMSAN. Although her platelet count recovered, her neurologic status remained poor, prompting therapy with plasmapheresis with subsequent mild improvement. A review of the literature revealed eleven previous cases of concurrent GBS and ITP; however, we report the first case of concurrent AMSAN and ITP. Among these cases, trends were noted to include sex, preceding infections, and cranial nerve involvement.