Summary
Clinical and laboratory data from a patient with Guillain-Barré syndrome indicated a probable etiological correlation of polyradiculitis to the intravenous administration of streptokinase. Oligoclonal IgG bands in the cerebrospinal fluid and serum were shown to be specific for streptokinase. Serum titers of streptokinase were elevated 64-fold for IgG, 16-fold for IgM, and 4-fold for IgA compared to controls. Clinical symptoms of Guillain-Barré syndrome are thought to result from streptokinase antibody complex mediated damage to the local blood-nerve barrier. The pathogenic relevance of autoantibodies to albumin and proteins of the central and peripheral nervous systems, occurring early after onset of symptoms, remains to be determined.
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Abbreviations
- CNS:
-
central nervous system
- CSF:
-
cerebrospinal fluid
- GBS:
-
Guillain-Barré syndrome
- IEF:
-
isoelectric focusing
- NF-L:
-
neurofilament light
- PNS:
-
peripheral nervous system
- SDS:
-
sodium dodecyl sulfate
References
Bell WR, Meek AG (1979) Medical intelligence. Current concepts: guide-lines for the use of thrombolytic agents. N Engl J Med 301:1266–1270
Bollensen E, Schachner M (1987) The peripheral myelin glycoprotein P0 expresses the L2/HNK-1 and L3 carbohydrate structures shared by neural adhesion molecules. Neurosci Lett 82:77–82
Cicale MJ (1987) Guillain-Barré syndrome after streptokinase therapy. Southern Med J 80:1068
Eden KV (1983) Possible association of Guillain-Barré syndrome with thrombolytic therapy (letter). JAMA 249:2020–2021
Erffmeyer JE (1986) Serum sickness. Ann Allergy 56:1105–1110
Gathier JC, Bruyn GW (1976) The serogenetic peripheral neuropathies. In: Vinken PJ, Gruyn GW (eds) Handbook of clinical neurology, vol 20, Elsevier/North-Holland, Amsterdam, New York, p 95
Guilbert B, Dighiero G, Avrameas S (1982) Naturally occurring antibodies against nine common antigens in human sera. I. Detection, isolation, and characterization. J Immunol 128:2779–2787
Hartung HP, Heininger K, Schäfer B, Fierz W, Toyka KV (1988) Immune mechanisms in inflammatory polyneuropathy. Ann NY Acad Sci 540:122–161
Ilyas AA, Willison HJ, Quarles RH, Jungalwala FB, Cornblath DR, Trapp BD, Griffin DE, Griffin JW, McKhann GM (1988) Serum antibodies to gangliosides in Guillain-Barré syndrome. Ann Neurol 23:440–447
Kaiser R (1991) Affinity immunoblotting: rapid and sensitive detection of oligoclonal IgG, IgA and IgM in unconcentrated CSF by agarose isoelectric focusing. J Neurol Sci 101:216–225
Koski CL, Humphrey R, Shin ML (1985) Anti-peripheral myelin antibody in patients with demyelinating neuropathy: quantitative and kinetic determination of serum antibody by complement component 1 fixation. Proc Natl Acad Sci USA 82:905–909
Kostulas VK (1985) Oligoclonal IgG bands in cerebrospinal fluid. Acta Neurol Scand 103 [Suppl] 1–112
Krajewski S, Szablowska-Krajewska M (1986) Disseminated vasculo-myelinopathy in the peripheral nervous system mediated by immune complexes. J Neurol Sci 72:131–145
Latov N, Gross RB, Kastelman J, Flanagan T, Lamme S, Alkaitis DA, Olarte MR, Sherman WH, Chess L, Penn AS (1981) Complement fixing antiperipheral nerve myelin antibodies in patients with inflammatory polyneuritis and with polyneuropathy and paraprotefnemia. Neurology 31:1530–1534
Leaf DA, MacDonald I, Kliks B, Wilson R, Jones SR (1984) Streptokinase and the Guillain-Barré syndrome (letter). Ann Intern Med 100:617
Reiber HO, Felgenhauer K (1987) Protein transfer at the blood cerebrospinal fluid barrier and the quantitation of the humeral immune response within the central nervous system. Clin Chim Acta 163:319–328
Roquer J, Herraiz J, Arnau D, Serrat R (1990) Guillain-Barré syndrome after streptokinase therapy. Acta Neurol Scand 82:153
Straub PW, Boersma J, Rhyner K, Schihin K (1974) Plasmozytose nach thrombolytischer Therapie mit Streptokinase. Schweiz Med Wochenschr 104:1891–1892
Ukkonen P, Ganström ML, Räsänen J, Salonen EM, Penttinen K (1981) Local production of mumps IgG and IgM antibodies in the CSF of meningitis patients. J Med Virol 8:257–265
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Kaiser, R., Kaufmann, R., Czygan, M. et al. Guillain-Barré syndrome following streptokinase therapy. Clin Investig 71, 795–801 (1993). https://doi.org/10.1007/BF00190321
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DOI: https://doi.org/10.1007/BF00190321