Search

Difteri, çocukluk ça¤›nda rutin olarak yap›lan afl›lama sayesinde yetiflkin insanlarda s›k olarak görülmeyen akut toksik bir infeksiyondur. Distalden bafllay›p proksimale do¤ru ilerleyen güçsüzlük, yumuflak damak paralizisi, göz hareket bozukluluklar› gibi nörolojik komplikasyonlar› difteriye ba¤l› toksik polinöropatinin Guillain-Barré sendromunda gözlenen polinöropati ile kar›flmas›na neden olabilir. Bu yaz›da, Guillain-Barré sendromu (GBS) belirtileriyle acil poliklini¤ine baflvuran ve klini¤imizde yap›lan de¤erlendirme sonras› difterik polinöropati tan›s› konan ve tedavi edilen 20 yafl›ndaki bir kad›n olgu sunulmufltur. ‹lk de¤erlendirmedeki nazone konuflmas›, bilateral horizontal nistagmus, distalden bafllay›p proksimale do¤ru ilerleyen güçsüzlük, yumuflak damak paralizisi, a¤›r disfaji ve disfoni gibi nörolojik bulgular› nedeniyle GBS ön tan›s› konan hastan›n yat›fl sonras› al›nan ayr›nt›l› öyküsünde, yaklafl›k 1 ay önce bir üst solunum yolu infeksiyonu sonras› kardiyoloji klini¤inde yat›r›ld›¤› ve o dönemdeki incelemeleri sonras› difteriye ba¤l› miyokardit tan›s› kondu¤u saptanm›flt›r. Ayr›ca mikrobiyolojik incelemeler ve öykünün derinlefltirilmesi sonras›nda mevcut tablosu ile difteriye ba¤l› polinöropati tan›s›n›n daha uygun olaca¤› kan›s›na var›lm›flt›r. Erken evrede birbiriyle çok benzeflen GBS’na ba¤l› polinöropati ve difterik polinöropati tablosunun ay›r›c› tan›s›n› yapmak ve do¤ru tan›y› koymak, tedavi yaklafl›m› ve sonras›nda hastal›¤›n prognozunu etkileyecektir. Diphtheria is an acute toxic syndrome which is rarely seen in adults due to extensive routine vaccination against causative agent. Neurological complications of progressive paresis, soft palate paralysis, eye movement disorders observed in diphtheria patients could lead to a diagnostic confusion with toxic polyneuropathy due to Guillain-Barré syndrome. In this article, a 20 year-old woman who had presented to the emergency service with symptoms similar to GuillainBarré syndrome (GBS) and was later diagnosed as diphtheritic polyneuropathy, is presented. Her initial neurological symptoms of speech disturbances, bilateral horizontal nystagmus, progressive paresis, soft palate paralysis, severe dysphagia and dysphonia led the physician to make a preliminary diagnosis of GBS and urgently hospitalize the patient. The detailed evaluation of her medical history revealed that she had upper respiratory infection one month ago and hospitalized in cardiology clinics with a diagnosis of diphtheritic myocarditis at that time. In her current hospitalization, she had received a final diagnosis of diphtheritic polyneuropathy after microbiological evaluations and differential diagnosis. Making correct diagnosis after appropriate differential diagnosis between GBS induced polyneuropathy and diphtheritic polyneuropathy at an early stage of disease would directly affect the treatment and prognosis of the disease.