Case 11: Could This Be Guillain-Barré Syndrome?

Dana Cummings, MD, PhDPreceptor: Thomas Crawford, MD

Disclosures

February 22, 2002

In This Article

Patient's Clinical Course

At the end of the initial encounter, we counseled the family regarding the possibilities for diagnosis. Further testing was put on hold. If the youngster did not improve, the family was instructed to call us and return to the hospital. The mother called 24 hours later, noting that patient was more irritable and acting as if it hurt for her to touch things with her hands.

Re-evaluation finds no changes in her neurologic exam

CSF examination. 0 WBC; 1 RBC; glucose 35 (serum not available); protein 11.

Laboratory data.

  • ESR: 87

  • WBC: 8500 (84 lymphocytes)

  • Hgb: 10.9

  • Hct: 31

  • Platelets: 140,000

  • LDH: 288 (140-260)

  • Uric acid: 4.8

  • Calcium: 9.0

  • Alkaline phosphatase: 113

The peripheral smear is shown in Figure 1. No blastocytes but mild leukopenia and thrombocytopenia were noted, and a bone marrow biopsy was performed (Figure 2).

Figure 1.

Peripheral smear shows no blastocytes but an atypical lymphocyte, mild leukopenia, and thrombocytopenia.

Figure 2.

Bone marrow biopsy shows B-cell precursor acute lymphocytic leukemia blasts (common ALL) with CD19+, CD10+, and partial CD34+ and CD20+ cells.

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