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LETTER TO THE EDITOR |
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A rare case report of Guillain–Barré syndrome presenting as unilateral facial palsy with isolated acute bulbar palsy
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| Date of Submission | 03-Jul-2020 |
| Date of Decision | 08-Jul-2020 |
| Date of Acceptance | 16-Jul-2020 |
| Date of Web Publication | 19-Jul-2021 |
Correspondence Address:
Mahmood Dhahir Al-Mendalawi,
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, P.O. Box 55302, Baghdad Post Office, Baghdad.
Iraq
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/jpn.JPN_178_20
Dear Editor,
In April–June 2020 issue of the Journal of Pediatric Neurosciences, Yadav et al.[1] reported a rare case of Guillain–Barré syndrome (GBS) presenting as unilateral facial palsy with isolated acute bulbar palsy in a 10-month-old Indian child. I have two comments on it.
First, GBS is generally rare in infancy and it exerts diagnostic challenges in the clinical field, particularly in atypical presentation. Human immunodeficiency virus (HIV) is well-known to be among many infectious agents that trigger GBS, particularly in HIV-endemic areas. Importantly, HIV-associated GBS could occur early in HIV infection, even at seroconversion stage.[2] India is among countries challenging the ongoing growth of HIV epidemic. The available data pointed out to the substantial HIV seroprevalence (1.03%) among pregnant in India.[3] Interestingly, HIV seroprevalence among babies exposed to maternal HIV until 24 months was estimated to be 7.8% (95% CI: 5.7–10.7).[4] I assume that some sort of vertical HIV transmission resulting in HIV-associated GBS in the studied patient ought to be considered. The HIV status of the mother was regrettably not defined. Confirming HIV positivity in the studied patient would have made the case in question the youngest pediatric patient with HIV- associated GBS in the literature. Unfortunately, tests for HIV detection were not done because of financial constraints.
Second, apart from increasing the alertness of the practicing pediatricians on the rare presentation of isolated cranial nerve palsy in infants with GBS, the case in question could really broaden the atypical clinical spectrum of infantile GBS already reported in the literature.[5]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Yadav P, Dhaka S, Chaudhary R, Damke S, Lohiya S. A rare case report of Guillain–Barré syndrome presenting as unilateral facial palsy with isolated acute bulbar palsy. J Pediatr Neurosci 2020;15:157-9.  [Full text] |
| 2. | Sloan DJ, Nicolson A, Miller AR, Beeching NJ, Beadsworth MB. Human immunodeficiency virus seroconversion presenting with acute inflammatory demyelinating polyneuropathy: a case report. J Med Case Rep 2008;2:370. |
| 3. | Sibia P, Mohi MK, Kumar A. Seroprevalence of human immunodeficiency virus among antenatal women in one of the Institute of Northern India. J Clin Diagn Res 2016;10:QC08-9. |
| 4. | Potty RS, Sinha A, Sethumadhavan R, Isac S, Washington R. Incidence, prevalence and associated factors of mother-to-child transmission of HIV, among children exposed to maternal HIV, in Belgaum district, Karnataka, India. BMC Public Health 2019;19:386. |
| 5. | Muthaffar OY, Mahmoud AA, Al-Saman AS. Acute hemiplegia as a rare presentation of infantile Guillain-Barré syndrome. Saudi Med J 2014;35:861-4. |
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