S5641 Guillain Barre Syndrome Acute Motor Axonal Neuropathy Mimicking Autoimmune Hepatitis: A Case Report of a Rare Entity

Introduction: This case report describes a possible association between autoimmune hepatitis (AIH) and Guillain-Barre Syndrome (GBS). While GBS is commonly associated with infections, such as Campylobacter jejuni, cytomegalovirus, viral hepatitis, Epstein-Barr virus, and Mycoplasma, an association between GBS and AIH has also been reported. Case Description/Methods: Here we describe a 71-year-old woman with a past medical history of hypertension, diabetes, and hyperlipidemia who presented with increased liver enzymes and upper and lower extremity distal weakness and tingling. EMG revealed Guillain-Barre syndrome acute motor axonal neuropathy (AMAN) form without any endorsed precipitating factors. Evaluation was negative for viral hepatitis but antinuclear antibody (ANA) antimitochondrial antibody (AMA) and smooth muscle antibody (SMA) were positive, in addition to a liver biopsy which showed features of autoimmune hepatitis. Her liver enzymes normalized after treatment of her axonal neuropathy with intravenous immunoglobulin. Discussion: This case raises important questions about immune cross-reactivity and diagnostic overlap. While autoimmune hepatitis and GBS target distinct organs, both may arise from aberrant immune responses. The absence of clinical hepatitis despite serologic and histologic findings may suggest subclinical AIH or a hepatic manifestation secondary to systemic immune activation from GBS. The normalization of liver enzymes following immunotherapy for GBS further supports an immune-mediated connection. Future studies may help delineate shared immunological pathways that could unify these conditions under a broader autoimmune umbrella.