Sergio Altomare*, Daniele Liuzzi, Maria Stella Aniello, Ruggiero Leone, Maria Superbo, Immacolata Plasmati, Michele Sardaro, Roberta Santoro, Rita Calabres, Leonarda D’Alessandro, Maurizio Giorelli
Guillain-Barre Syndrome (GBS) is an acute polyradiculoneuropathy leading to flaccid paresis. A Treatment-Related Fluctuation (TRF) in a patient with Guillain-Barré Syndrome (GBS) is defined as clinical deterioration within two months of symptom onset following previous stabilization or improvements with treatment. A 67 years old woman presented with rapidly progressing muscular weakness in all four limbs. Her nerve conduction study revealed demyelinating polyneuropathy in all four limbs, and her test of the cerebrospinal fluid showed an albumin-cytologic dissociation. She improved after intravenous immunoglobulins but she had two relapses within two months. Later on mixed cryoglobulins were detected and nerve conduction studies revealed mixed demyelinating and axonal polyneuropathy. We assume that cryoglobulins could be a factor precipitating fluctuations in Guillain-Barrè after suspending therapy and that, in particular conditions they should be tested in order to start a specific therapy and to prevent clinical relapses.