Description
●Summary of the Case:
➣Patient Profile: 82-year-old man with a confirmed diagnosis of type 2 diabetes.
➣The main complaint was abrupt, progressive ascending quadriparesis that lasted for five days.
➣ Related symptoms include:
• 14 days of high-grade fever and right loin discomfort;
• No involvement of the face, bulbar region, respiratory system, colon, or bladder.
• No history of diarrhoea, illness, or immunisation.
➣ Clinical Examination:
• Neurological findings:
→ Lower motor neurone (LMN) type symmetrical areflexic quadriparesis;
→ No autonomic, bulbar, or cranial nerve dysfunction.
• Systemic findings: No organomegaly, including hepatosplenomegaly.
● Neurological Assessment:
➣CSF, or cerebrospinal fluid:
• Elevated protein: 249.2 mg/dl
• Normal cell count: 2 cells/cmm → GBS-typical albuminocytologic dissociation.
➣ Acute Motor Axonal Neuropathy (AMAN) is a subtype of GBS, according to the results of the Nerve Conduction Study (NCS).
• The characteristics of sensory conduction were normal.
● Serological and microbiological tests:
➣ ANA, HBsAg, and HIV (1+2): Negative.
➣ Infection with Mycobacterium tuberculosis is supported by a positive Interferon-Gamma Release Assay (IGRA).
➣ Gramme stain, Ziehl-Neelsen stain, and Xpert MTB/RIF sputum tests: Negative.
●Imaging Results:
➣MRI Spine with Contrast:
• Shown a psoas abscess on the right side.
• The caseous granuloma found in the abscess's FNAC confirmed the tubercular aetiology.
➣HRCT Chest:
• Bilateral mild-to-moderate pleural effusion;
• Right upper lobe thick-walled cavitary lesion.
• Results point to active tuberculosis in the lungs.
● Final Conclusion:
➣ Acute Motor Axonal Neuropathy form of Guillain-Barré Syndrome with subsequent tuberculosis.
● Clinical Importance:
➣ Atypical presentation: It is uncommon for GBS to appear as the first sign of widespread TB.
➣ Pathophysiological connection:
• Mycobacterium tuberculosis antigens cause immune-mediated demyelination or axonal damage.
• Based on a chronic infection, it resembles traditional post-infectious GBS.
➣ Significance for diagnosis:
• Low cell count and psoas abscess findings, along with elevated CSF protein, indicated tubercular aetiology.
• Studies of nerve conduction are essential for identifying subtypes (AMAN).
➣ Clinical message:
• GBS cases in endemic areas should raise a high suspicion of tuberculosis, particularly if there are evidence of a systemic infection.
Protocol
●Management and Treatment:
➣Antitubercular Therapy (ATT): Initialisation of the standard four-drug regimen.
➣Steroids: Used to control immunological response and inflammatory neuropathy.
➣Supportive therapy:
• includes physiotherapy for the recovery of motor skills.
• Autonomic and respiratory function monitoring.
• Because of diabetes, glucose control is optimised.
● Nursing Management Techniques and Interventions :
→ These issues are addressed by evidence-based nursing interventions:
➣Personalized Patient Education: Nurses offer patients individualised instruction to help them manage chronic conditions like diabetes and heart failure on their own, which improves treatment compliance and clinical results.
➣Medication Management: Nurses increase adherence and decrease medication errors through reconciliation and routine reviews, which lowers adverse events and readmissions to the hospital.
➣Infection Control: Strict isolation and hand hygiene guidelines are used to prevent the transmission of illnesses and drastically lower the number of infections linked to healthcare.
➣Pain Management: To reduce pain intensity and enhance patient satisfaction, non-pharmacological methods (such as music therapy) and patient-controlled analgesia are employed.
➣Continuing Nursing and Follow-Up: Platforms for managing chronic diseases and frequent reminders (like SMS follow-ups) guarantee that patients keep their appointments and care plans, providing continuous support and direction.
➣Psychological Support: To improve patients' mental health and promote resilience and a positive attitude towards treatment, regular counselling and emotional support are offered.
➣Team-Based Care: Nurses play a key role in coordination, and regular interdisciplinary team meetings assist coordinate treatment plans and promote consistency in care.
Notes
For more details visit https://doi.org/10.1016/j.clinpr.2024.100383