331 - Progression of Acute Motor Axonal Neuropathy in Acute Rehabilitation: A Case Report

Case Diagnosis: Acute Motor Axonal Neuropathy (AMAN) variant of Guillain-Barre Syndrome

Case Description: A 48-year-old male presented to the hospital with a 1 week history of acutely progressive proximal worse than distal upper and lower extremity weakness and dysphagia 9 days after a febrile diarrheal illness. Patient reported recent travel to Morocco, where he initially felt feverish, but improved in a couple of days. Patient ultimately underwent an EMG, which was consistent with Acute Motor Axonal Neuropathy (AMAN). Otherwise, the workup was unremarkable, including unsuccessful lumbar punctures and serum antibody studies. The patient was treated with a 7 day course of intravenous immunoglobulin (IVIg) with improvement of dysphagia, but he continued to have pain in the bilateral hip flexors and weakness. Upon presentation to acute rehabilitation, therapy targeted functional mobility, motor control, and dynamic standing balance.

Discussions: Guillain-Barre Syndrome (GBS) affects approximately 1 to 2 people per 100,000 population each year, its prevalence varying from region to region, typically after an infectious disease. GBS is not a single disease but rather a group of closely related conditions and subtypes, including AMAN. Literature concerning AMAN and its prognosis is sparse, primarily focusing on IVIg or plasmapheresis (PLEX) as the mainstay of treatment. However, the efficacy of IVIg or PLEX may not be the same across all subtypes. Its unpredictable nature necessitates ongoing care and continued rehabilitation while monitoring outcomes in order to optimize patient functionality. However, our patient’s continued pain and weakness despite a 7-day course of IVIg indicate that more therapies are needed to improve patient prognosis and recovery.

Conclusions: AMAN is a rare variant of GBS with limited knowledge regarding its long-term prognosis. It is imperative to recognize symptoms early for prompt diagnosis and maintain long term follow-up for further investigation into creating optimal treatment plans for patients.