Acute Motor Sensory Axonal Neuropathy (AMSAN), a variant of Guillain Barré syndrome in a patient of Non-small cell Lung Carcinoma- A Case Report.

Abstract Introduction: Guillain Barré Syndrome (GBS), has been commonly seen as a paraneoplastic manifestation in patients of small cell lung cancer. However, few published case reports of GBS are seldom re-ported in non-small cell lung cancer patients worldwide. Case report: Here, we present the case of a 38 year old male, non-smoker, diagnosed with non- small lung carcinoma, specifically Ana-plastic Lymphoma Kinase (ALK) positive pulmonary adenocarcinoma with brain metastasis, treated with chemotherapy and palliative whole brain radiotherapy, that developed sudden onset weakness of all four limbs, along with bulbar involvement and respiratory compromise. The patient was diagnosed as Acute Motor Sensory Axonal Neuropathy (AMSAN), a variant of GBS, based on the Cerebrospinal Fluid (CSF) analysis and nerve conduction studies. He was treated with Non-In-vasive Ventilation (NIV) and Intravenous Immunoglobulin (IVIG) 2 gm/kg body weight over 5 days, after which he recovered satisfactorily. Conclusion: To our knowledge, this is the first case report in India where AMSAN variant of GBS, developed in a patient of non-small cell lung carcinoma. We recommend that the oncologists should be cognizant of GBS presenting either as a paraneoplastic neurological syndrome or as a immune related adverse events of Immune Check-point Inhibitor (ICI) drugsused to treat patients of non-small cell lung cancer.