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Lead Poisoning Can Be Misdiagnosed as Guillain-barre Syndrome: A Case Report

Abbas Aghabiklooei, Maryam Ameri
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Abstract

Background: Toxic neuropathy is a global health problem affecting many people over the world, annually. Lead Poisoning (LP) represents neurological complaints and neurobehavioral disorders. Therefore, its significances, especially its neurological consequences, can be misdiagnosed as other neuropathies like syndromes.
Case Presentation: In this case report, we aim at describing a 45-year-old woman with Guillain-Barre-like Syndrome (GBS), who was admitted to the hospital with peripheral neuropathy and complaints of paresthesia in the lower and upper limbs. Suffering from GBS-like syndrome, she incidentally showed opium consumption during the hospitalization and taking her history. Serum lead levels were precisely elevated (88.6µg/dL). To assess the neurologic effects, the brain CT, MRI, EMG, and NCV were performed, indicating severe sensory-motor demyelinating polyradiculopathy. The patient was admitted to the hospital again after 2 years with severe radicular pain in the lower and upper limbs and with positive myoclonus and tremor. While treated with plasma exchange and pregabalin at the first stage of admission, signs were normal and again recurred after 2 years, suggesting the reversibility of the histological findings and misdiagnosis. At the second stage, Intravenous Immunoglobulin (IVIG) was prescribed. The patient recovered and was discharged with chelation therapy of CaNa2EDTA for LP. The most frequent neurological complication induced by LP is severe sensory-motor demyelinating polyradiculopathy and axonal polyneuropathy. But, the clinical examination and the electrophysiological findings may also suggest a GBS-like syndrome.
Conclusion: Any discrepancies in this regard should be reconsidered to confirm LP diagnosis.


Keywords

Guillain-Barre syndrome, Lead Poisoning, Toxic neuropathy

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DOI: https://doi.org/10.22037/ijmtfm.v9i3%20(Summer).22916