A 24-year-old housewife developed
double vision, tingling sensation, and weakness in the legs following a flu-like illness. She then developed
dysphagia and difficulty in standing. On admission her eyes were fixed in midline due to
ophthalmoplegia. Doll's eye sign was negative. She had severe generalized
muscle weakness and no sensory deficits. All tendon reflexes were lost. CSF
protein was 58 mg/dl with cell count of 2/mm3.
Antibodies to campylobacter jejuni, mycoplasma, EBV, and other microbes were negative. We treated her with
plasmapheresis after which she showed rapid clinical recovery, although the
ophthalmoplegia improved slightly later. Increased titer of
IgG class
antibodies to GD1b and to GQ1b, and of
IgM antibody to GQ1b, were detected in the serum taken during the acute phase of the illness. In parallel with clinical amelioration, both the anti-GD1b and -GQ1b
antibodies decreased in titer, or became negative. Since there is no common
epitope to GD1b and GQ1b
gangliosides, we speculated that the anti-GD1b and -GQ1b
antibodies were induced independently by different
antigens in this patient. Moreover, the presence of high titer
IgM antibody to GQ1b possible indicates that this patient was at the relatively early stage of
infection of unknown microbe, which then induced the
IgG antibodies to GD1b and GQ1b by cross sensitization, which might correlate with the
tetraplegia and the
ophthalmoplegia, respectively.