Guillain-Barre Syndrome with Lymphocytic Pleocytosis of the CSF

Introduction: Guillain-Barre typically presents as a symmetric ascending weakness with areflexia. The cerebrospinal fluid typically shows albuminocytologic dissociation. In this case, we present an atypical presentation of severe Guillain-Barre with cerebrospinal fluid exhibiting lymphocytic pleocytosis. Case report: 60-year-old man presented with progressive lower- extremity weakness that progressed to involve respiratory failure and areflexia over several weeks. Electromyography showed both demyelinating and axonal features. Lumbar puncture revealed a lymphocytic pleocytosis. Given the abnormalities on these tests with a clinical picture of Guillain-Barre the patient underwent extensive paraneoplastic testing and full neuro-axis imaging. Imaging revealed abnormal enhancement of ventral and dorsal nerve roots which is consistent with Guillain-Barre. Conclusion: In conclusion, a diagnosis of Guillain-Barre syndrome may still be considered in a patient with clinical findings and EMG studies consistent with GBS but with a CSF profile that does not show the typical albuminocytologic dissociation. However, all other causes of CSF lymphocytic pleocytosis must be ruled out before coming to this conclusion.