Tick-borne encephalitis complicated by Guillain-Barré syndrome in a 17 year old patient: case report

Guillain-Barré syndrome (GBS) presents as acute, monophasic, non febrile, ascending weakness with or without hyporeflexia, usually follows after acute illness. But Tick-borne encephalitis (TBE) presents with variety of neurological symptoms from mild to severe neurological disease. We describe a case report of a 17 year old patient with atypical presentation of recurrent GBS mimicking TBE although the patient had undergone full TBE vaccination. Diagnostic test showed positive IgG and IgM antibodies to TBE in the cerebrospinal fluid and positive IgG and border -line IgM antibody values in the serum. The recurrent episode of GBS in the patient presented with a more severe limb weakness with progressive hyporeflexia. The patient underwent repeated course of intra-venous immunoglobulin (IVIg) therapy during 40 days, full course of rehabilitation therapy. Underlying conditions and atypical presentation of the disease could need a reevaluation of the blood tests especially in the pediatric patients.