Razi Journal of Medical Sciences

Case Presentation: A 7-year-old girl initially presented with nonspecific symptoms including headache, generalized weakness, lethargy, and myalgia. She was treated for a suspected dental abscess with antibiotics but returned four days later with worsening neurological symptoms, including inability to walk, dysarthria, neck pain, and episodes of “staring spells.” Initial lab work revealed neutropenia (ANC ~1275) with normal inflammatory markers (CRP<1, ESR=7). CT neck initially described a small suprasternal soft tissue density, which was not confirmed on subsequent ultrasonography. MRI of the brain and spine was unremarkable.

The critical diagnostic finding was obtained through EMG/NCV, which revealed acute demyelinating sensorimotor polyneuropathy consistent with GBS.

Discussion and Conclusion: This case demonstrates that atypical triggers such as dental infections can play a role in the onset of GBS. Previous studies have reported respiratory and gastrointestinal infections as the most common antecedent events, but this case underscores the need to consider other infectious sources. Additionally, the patient had a history of severe psychological stress, which may have contributed to disease severity through activation of the hypothalamic-pituitary-adrenal (HPA) axis and increased cortisol levels.  

From a psychiatric perspective, the patient was diagnosed with Adjustment Disorder with Anxiety and received pharmacological treatment. This coexistence illustrates that anxiety can act both as a trigger and as a consequence of the disease. Recent studies have shown that anxiety in children with autoimmune diseases may be associated with neuroendocrine changes, thereby intensifying neurological symptoms.

immunological mechanisms such as molecular mimicry between bacterial antigens and myelin gangliosides can lead to the production of aberrant antibodies against myelin, ultimately resulting in demyelination of peripheral nerves.

Clinically, this case highlights the importance of thorough neurological evaluation, including EMG/NCV, in the presence of confounding factors such as ambiguous radiological findings or psychiatric symptoms. Key neurological signs, such as areflexia, remain crucial in guiding the diagnostic process.  

In conclusion, this case illustrates that dental infections, though uncommon, can act as triggers for GBS, and severe psychological stress may exacerbate disease severity. A holistic approach that integrates immunological, neurological, and psychiatric perspectives is essential in managing pediatric patients with acute weakness.