Guillain-Barre syndrome associated with peginterferon alfa-2a for chronic hepatitis C: A case report

Table 1 Time line showing the clinical course of the patient

Period 2008-09	Event	HCV RNA IU/mL	WBC×103/μL	ANC/μL	Hb g/dL	Platelets×103/μL	ALT IU/L	BT mg/dL	TSH IU/mL	IFN dose/wk	RBV dose/d
Early December	Start of HCV treatment	4 275 000	5.6	3600	15.9	NCa	66	0.7	1.55	180 mcg	1000 mg
Early January	Platelets decreased	309 230	5.0	2300	14.5	31	57	1.0	NA	135 mcg	No change
Late January	Start of neurological symptoms	18 880	3.9	1400	12.7	45	38	0.8	NA	Treatment held
Mid February	Worsening of symptoms	NA	6.4	4000	15.1	61	59	0.6	1.92	Treatment on hold
April	F/U visitb improvement in symptoms	499 660	7.2	4400	15.8	94	61	0.6	NA	Treatment on hold

ANC: Absolute neutrophilic count; Hb: Hemoglobin; BT: Bilirubin total; IFN: Interferon; RBV: Ribavirin; F/U: follow-up; NA: Not available; NC: Not calculated.

^aDue to clumping of platelets, result was not recorded. Later on repeating, platelets were found to be 55 × 10³/μL;

^bLast follow up to hepatology clinic but patient is being followed up regularly by the neurologist in clinic and by hepatology staff.

Table 2 Electromyography studies

Side	Muscle	Nerve	Root	Insertional activity	Fibrillations	Psw	Amp	Dur	Poly	Interphase pattern
Right	MedGastroc	Tibial	S1-2	Nml	Nml	Nml	Nml	Nml	0	Nml
Right	AntTibialis	Deep br peroneal	L4-5	Nml	Nml	Nml	Nml	Nml	0	25%

Nml: Normal; Psw: Positive sharp waves; Amp: Amplitude; Dur: Duration; Poly: Polyphase activity. Electrical activity of the muscles at rest (Insertional activity, Fibrillations, Psw) and with voluntary activation (Amp, Dur, Poly, Interphase) showing that most of the results were normal, reflecting that patient had an acute event of neurological symptoms and did not have a chronic ongoing muscle disease.

Table 3 Nerve conduction studies

	Distal latency (m/s)	Conduction velocity (m/s)	Amplitude sensory (uV) motor (mV)
Sensory
Right radial	2.8 (NML < 2.6)		11 (NML > 20)
Right sural	Absenta		Absenta
Motor
Right median	6.0 (NML < 4.4)	37 (NML > 49)	5.6 (NML > 4.2)
Right ulnar	4.1 (NML < 3.5)	41 (NML > 49)	6.0 (NML > 5.6)
Right peroneal	11.4 (NML < 5.7)		0.7 (NML > 2.2)
Right tibial	12.1 (NML < 5.7)		1.0 (NML > 2.8)
F wave
Right median	33 (NML < 31)
Right ulnar	27.6 (NML < 31)
Right peroneal	Absent
Right tibial	Absent

^aTechnically difficult; NML: Normal.