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Case presentation:

A 79-year-old male with a history of coronary artery disease s/p PCI presented with fever and diplopia. Initially, he experienced a dry cough and malaise for a week, followed by watery diarrhea five days later and fever with diplopia the next day. Examination revealed left-beating nystagmus, postural tremor in both arms, intermittent leg jerking, and exaggerated reflexes in the biceps and patella (+3). No sensory deficits or meningeal signs were present. Motor exam confirmed full strength (5/5) in all extremities, but tremors prevented walking. Brain MRI +/- contrast revealed T2 hyperintensity in the left superior cerebellar hemisphere, without mass effect or abnormal enhancement. MRI of the spine showed severe stenosis at L4-L5. Full-body CT was clear of neoplasm or infection. Laboratory results were normal. CSF analysis showed 13-20 WBC, 0-1 RBC, 82 mg/dl protein, and normal glucose. Blood cultures detected C. jejuni sensitive to meropenem. Following antibiotic therapy, the patient experienced significant clinical improvement and was discharged with a 14-day course of meropenem. Mobility improved significantly after three months of physical therapy, with minimal residual neurological symptoms. Follow-up MRI confirmed resolution of the cerebellar signal abnormality.

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Discussion :

Campylobacter infections can impact the CNS, potentially resulting in various conditions including GBS, transverse myelitis, acute disseminated encephalomyelitis (ADEM). These conditions are caused by cross-reactivity between Campylobacter epitopes and components of the axon and myelin, causing an immune-mediated inflammatory demyelination of the nervous system. Except for ADEM, all these diseases involve progressive demyelinating peripheral polyneuropathy.

In patients with an atypical presentation, the diagnosis of GBS is often delayed. However, given the improvement of symptoms with antibiotics, it was likely in the setting of Campylobacter septicemia. Steroid therapy was not initiated during hospitalization. This case report highlights the spectrum of neurological complications associated with Campylobacter.