Hymenoptera sting as atypical causative factor for Guillain Barré Syndrome and chronic inflammatory demyelinating polyneuropathy – A case report and insights on pathophysiology

Introduction. Neurological manifestations secondary to Hymenoptera stings are rare. However, the literature describes cases of severe central and peripheral nervous system damage. Suspected pathophysiological mechanisms include hypoxic-ischemic damage, demyelination, and the direct neurotoxic effect of venoms. In this context, bee stings could be a possible atypical causative factor for Guillan–Barré syndrome and chronic inflammatory demyelinating polyneuropathy. Case report. We present the case of a 32-year-old patient who declared the presence of a bee sting two weeks before the onset of neurological manifestations (flaccid quadriparesis, predominantly distal, with paresthesia at the same level) that were initially diagnosed as a Guillain Barré syndrome. Despite the treatment with immunoglobulins in the acute phase, the worsening of the motor deficit after one month required a new course of immunoglobulins, associating corticosteroids, with initially favorable evolution. However, the presence of a new relapse after eight weeks, correlated with changes such as albumin-cytological dissociation in the examination of the cerebrospinal fluid and the appearance of active denervation on the electroneuromyography study, established the final diagnosis of chronic inflammatory demyelinating polyneuropathy. Conclusions. We consider the presented case proof of the relationship between the Hymenoptera sting and various peripheral nervous system pathologies. Inflammatory and demyelinating changes common to Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy appear to be the primary pathophysiological mechanism to explain this uncommon correlation

COULD BE CONSIDERED SERUM ANTI-S-100 AUTOANTIBODIES A BIOMARKER IN PATIENTS WITH ACUTE NON-CARDIOEMBOLIC ISCHEMIC STROKE?

In ischemic stroke patients there were found autoantibodies against brain epitopes. The presence of anti-S-100 autoantibodies may reflect alteration and dysfunction of the blood-brain barrier. The aim of the study was to assess the prevalence of serum anti-S-100 autoantibodies in the early stage of ischemic non-cardioembolic stroke and their correlation with clinical outcome. The study included 78 patients with acute non-cardioembolic ischemic stroke, 46 females and 32 males, ranges from 46 to 81 years, mean age 74.3±6.8 years. Blood samples for anti-S-100 autoantibodies measurement were taken within 24 hours after the onset of ischemic stroke. Seventy-two patients served as matched controls 43 females and 29 males, ranges from 42 to 79 years, mean age 71.3±6.4 years. Serum anti-S-100 autoantibodies were measured by means of ELISA. Significance difference between groups was calculated by the Wilcoxon signed rank method. A value of p<0.05 was considered significant. Anti-S-100 autoantibodies were detected in 25 patients (32%). Patients with acute ischemic stroke had significantly higher levels of anti-S-100 autoantibodies (87.3±9.23 IU/ml) as compared to healthy controls (23.1±1.17 IU/ml) (p<0.01). In 24 patients the cerebral CT scan was negative in the first 24 hours, out of them in 6 patients anti-S-100 autoantibodies were positive. The higher titers correlated significantly with worse clinical outcome (132.0±12.4 IU/ml; p<0.001). The negative predictive value of anti-S-100 autoantibodies was 87%, and positive predictive value of anti-S-100 autoantibodies was 71%. Measurement of anti-S-100 autoantibodies may be used to select patients with early negative cerebral CT scanning as presenting ischemic stroke

Diagnostic and Treatment Challenges of Emergent COVID-Associated-Mucormycosis: A Case Report and Review of the Literature

Mucormycosis is a rare fungal infection, with high mortality, commonly associated with diabetes, malignancies, immunosuppressive therapy, and other immunodeficiency conditions. The emergence of mucormycosis cases has been advanced by the COVID-19 pandemic. Clinical presentation is variable, from asymptomatic to persistent fever or localized infections. We present a case of a Romanian old man, without diabetes or other immunodepression, with COVID-19 who developed severe rhino-orbital mucormycosis and bacterial superinfections, with Pseudomonas aeruginosa and Klebsiella pneumoniae. The late diagnostic and antifungal treatment was related to extensive lesions, bone and tissue loss, and required complex reconstruction procedures. We review the relationships between mucormycosis, COVID-19, and bacterial associated infections. The suspicion index of mucormycosis should be increased in medical practice. The diagnostic and treatment of COVID-19-Associated-Mucormycosis is currently challenging, calling for multidisciplinary collaboration