Objective:

NA

Background:

Facial diplegia with paresthesias (FDP) is a rare Guillain-Barré Syndrome (GBS) subtype typically presenting as a monophasic illness with rapidly progressive bilateral facial weakness and distal limb sensory changes. Unlike other GBS subtypes, FDP usually occurs without significant limb weakness or additional cranial nerve involvement. This variant may follow a preceding infectious illness and has been associated with anti-ganglioside antibodies, most commonly anti-GM2. This case expands both the antibody profile and the spectrum of underlying etiologies associated with FDP.

Design/Methods:

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Results:

A 57-year-old woman with history of chronic lower back pain presented with 10 days of progressive facial weakness and paresthesias in her distal upper and lower extremities. She initially noticed weakness in the left side of her face, followed by the right. Paresthesias appeared in all extremities, mainly in the distal areas. She denied recent infections or sick contacts. On admission, serum inflammatory markers were mildly elevated. CSF studies showed an elevated white blood cell count of 10 cells/µL (96% lymphocytes), elevated protein at 53 mg/dL, and positive anti-GD1a antibodies. She was ultimately diagnosed with facial diplegia with paresthesias. MRI of the neuroaxis was unremarkable. CT scans of the chest, abdomen, and pelvis showed axillary and retroperitoneal lymphadenopathy. She underwent biopsy of the axillary lymph node, and its pathology demonstrated a follicular large B-cell lymphoma. Her symptoms improved significantly after completing a course of intravenous immunoglobulin and starting chemotherapy. 

Conclusions:

This case illustrates a diagnostic approach in evaluating a patient with FDP as well as pertinent management considerations. While FDP has been most commonly associated with anti-GM2 antibodies, our findings support its association with anti-GD1a antibodies. This further broadens the immunologic profile of FDP and highlights the need to consider an underlying malignancy, particularly when a post-infectious etiology seems less likely.