402 - A Rare Case of Combined Central and Peripheral Demyelination following Haemophilus Influenzae Meningitis

Case Diagnosis: 27-Year-Old Male with Guillain-Barre Syndrome and Optic Neuritis

Case Description: Patient presented with acute onset leg weakness and decreased respiratory drive. LP/CSF studies revealed H. Influenza meningitis. MRI brain and C-spine were unremarkable. The Patient was diagnosed with GBS and completed IVIG with improvement in weakness. While in Inpatient Rehab the Patient developed acute right vision loss. Repeat MRI brain without contrast revealed multiple demyelinating lesions across both hemispheres. MRI orbit revealed optic nerve with T2/flair hyperintensity with enhancement of right canalicular and intra-orbital optic nerve consistent with Optic Neuritis. Additional studies which included Serum ANA, ACL ab, ACE, ANCA, Sjogrens AB, aquaporin 4 ab and anti- MOG antibody studies were negative. Repeat LP/CSF studies were unremarkable. The patient then completed a 5-day course of IV Solu-Medrol with plans to start Siponimod. During follow up the patient reported complete resolution of right vision loss but continued to endorse paresthesias and neuropathic pain in hands and feet.

Discussions: Optic neuritis and subsequent vision loss is a rare feature of Guillain-Barre Syndrome. The combination of GBS and Optic Neuritis is classified as a subtype of Combined Central and Peripheral demyelination (CCPD) which is usually post-infectious. Contrary to published reports of CCPD, our patient reported complete resolution of right vision loss. There are only a handful of reported cases with recovery of visual acuity to 20/25 or higher. CCPD may also include chronic and relapsing forms like CIDP and Multiple Sclerosis.

Conclusions: The combination of Optic Neuritis and Guillain-Barre Syndrome is rare phenomenon and reflects a disease process that leads to Combined Central and Peripheral Demyelination (CCPD). CCPD should be considered in GBS patients who develop acute vision loss. While there are few cases reported in literature with complete recovery of vision, this case reveals how prompt detection and early intervention may lend to improved outcomes.