PMC10244661_01
Magnetic resonance imaging and magnetic resonance angiography of the patient's brain. Diffusion-weighted (DWI) sequence revealed multiple acute or subacute lacunar infarcts in bilateral frontoparietal watershed areas (A-C). Magnetic resonance angiography showed normal (D).
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Cranial MRI with magnetic resonance angiography revealed multiple acute or subacute lacunar infarcts in the bilateral frontoparietal watershed areas (refer to Figure 1). Chest CT scanning on admission revealed diffuse ground-glass-like opacity in the lower lobe of both lungs (Supplementary Figure S1).
Clinical course of platelet count and LDH change in this patient during the first 72 days.
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Laboratory investigations showed mild anemia (hemoglobin 114 g/L), severe thrombocytopenia 7 x 109/L (normal value: 100-300 x 109/L) (Figure 2), high levels of total bilirubin 6.95 mg/dL (normal value: 0-1.35 mg/dL) and indirect bilirubin 6.11 mg/dL (normal value: 0-1.11 mg/dL) with normal serum alanine transaminase (ALT) and aspartate aminotransferase (AST), lactate dehydrogenase (LDH) 1,011.88 U/L (Figure 2), normal blood creatinine and urea nitrogen, high levels of D-dimer (1,130 ng/mL), and a clear increase in ferritin > 1,650 ng/mL. On the 12th day of consecutive TPE and dexamethasone treatments, the patient's platelet count increased to 299 x 109/L, and his LDH level decreased to 248.17 U/L (Figure 2).
Nerve conduction study (NCS) of the patient on day 12 of admission showed a decrease in compound muscle action potential (CMAP) of all examined motor nerves (A), and the F wave was absent in the median and tibial nerves (B). Re-examination of NCS on day 72 revealed a significant improvement in the CMAP decrease in all motor and sensory nerves compared to that on day 12 of admission (C), and normal F waves in the ulnar and tibial nerves were observed (D).
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Nerve conduction studies confirmed the acute inflammatory demyelinating polyradiculopathy (AIDP) variant of GBS, which showed a decrease in compound muscle action potential (CMAP) of all examined motor nerves, with the F wave absent in the median and tibial nerves, while other testing revealed normal results (Figure 3). ALT, AST, blood creatinine, urea nitrogen, LDH, and bilirubin levels were all within normal ranges. A re-examination of the nerve conduction study on day 72 showed a significant improvement in CMAP decrease in all motor and sensory nerves compared to the previous one, with normal F waves observed in the ulnar and tibial nerves (Figure 3).