Guillain–Barré syndrome in a cancer patient treated with bevacizumab

Abstract

We describe a case of Guillain–Barré syndrome (GBS) in a patient treated with bevacizumab. Our case is a 60-year-old woman with Stewart–Treves syndrome (STS), and angiosarcoma of her left forearm, with onset 12 years after diagnosis with stage IIIA left breast cancer. She suffered from repeated distal metastases including skin, bone, and liver metastases. She underwent numerous treatments including left arm amputation, radiation, and chemotherapy, but her disease was resistant. Thereafter, she received bevacizumab. Two weeks following the first administration, she presented in poor physical condition. Although the cause was not specified at that time, bevacizumab was discontinued. At 1 month following first bevacizumab administration, she gradually developed dyspnea, and numbness in her tongue and hands. Soon after, she was emergently admitted to the hospital due to hyperventilation syndrome. On hospital day 4, she developed quadriparesis, and on hospital day 8, she was diagnosed with GBS following neurological testing. Treatment with intravenous immunoglobulins was started immediately upon diagnosis, and her neurological symptoms eventually resolved. A repeat challenge course of bevacizumab was avoided. Five months later, the patient perished from STS progression. GBS associated with malignancies and/or chemotherapies has been rarely described in patients with malignant lymphomas. Of note, there is only one reported case of GBS with bevacizumab. Furthermore, in some cases, GBS is lethal, and it should be considered in the differential diagnosis of patients treated with bevacizumab.

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