Guillain-Barré syndrome caused by intravesical instillation of Bacillus Calmette-Guérin

Akan, Serkan and Atmaca, Melek Colak (2024) Guillain-Barré syndrome caused by intravesical instillation of Bacillus Calmette-Guérin. IDEGGYOGYASZATI SZEMLE / CLINICAL NEUROSCIENCE, 77 (1-2). pp. 65-68. ISSN 0019-1442

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Abstract

Introduction – Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinat- ing polyneuropathy. In the vast majority of patients, 1-4 weeks before the onset of GBS-related symptoms, an event such as up- per respiratory tract or gastrointestinal tract infection, surgical intervention or vaccination is present. To the best of our knowledge, this is the first case of GBS that occurred after intravesical Bacillus Calmette-Guérin (BCG) therapy in the absence of tuberculosis or any other infection in the English literature. Case report – A 65-year-old male patient, who had no systemic disorders except hyperten- sion and coronary artery disease, underwent transurethral resection of a bladder tumour further to imaging studies investigating macro- scopic haematuria. A pathologic examination revealed a non-muscle-invasive high-grade (pT1HG) transitional cell carcinoma. Immedi- ately after the fourth cycle of intravesical BCG, which was administered 2 months after sur- gery, the patient experienced numbness and weakness in his lower and upper extremities, respectively. There were no signs or symp- toms related to an acute cranial pathology or infectious disease. Nerve conduction studies, which were carried out on the 7th day after the onset of the neurologic symptoms, revealed a demyelinating sensorimotor polyneuropathy with mild secondary axonal damage in upper and lower limbs with a sural sparing pattern. Conclusion – Without tuberculosis infection, GBS can occur secondary to increased im- mune response and antibodies triggered by intravesical BCG therapy. However, consider- ing the worldwide use of BCG vaccination and thousands of intravesical BCG therapies, this is a very rare adverse effect.

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