P3888 - Guillain Barre Syndrome Acute Motor Axonal Neuropathy Mimicking Autoimmune Hepatitis: A Case Report of a Rare Entity

Ibrahim Abdelmotelib, MD¹, Dauris Rosario, MD², Sheila Eswaran, MD², Hazem Abosheaishaa, MD³, Omar Abdelhalim, MD⁴, Nancy Reau, MD, FACG²
1Cairo University School of Medicine, Cairo, Al Qahirah, Egypt; 2Rush University Medical Center, Chicago, IL; 3Mount Sinai West, Icahn School of Medicine at Mount Sinai, Queens, NY; 4Icahn School of Medicine at Mount Sinai, Queens, NY

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 female 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.

Disclosures:
Ibrahim Abdelmotelib indicated no relevant financial relationships.
Dauris Rosario indicated no relevant financial relationships.
Sheila Eswaran indicated no relevant financial relationships.
Hazem Abosheaishaa indicated no relevant financial relationships.
Omar Abdelhalim indicated no relevant financial relationships.
Nancy Reau: AbbVie – Grant/Research Support. Arbutus – Advisor or Review Panel Member. Gilead – Advisory Committee/Board Member, Grant/Research Support. Salix – Advisory Committee/Board Member, Grant/Research Support. VIR – Advisory Committee/Board Member, Grant/Research Support.

Ibrahim Abdelmotelib, MD¹, Dauris Rosario, MD², Sheila Eswaran, MD², Hazem Abosheaishaa, MD³, Omar Abdelhalim, MD⁴, Nancy Reau, MD, FACG². P3888 - Guillain Barre Syndrome Acute Motor Axonal Neuropathy Mimicking Autoimmune Hepatitis: A Case Report of a Rare Entity, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.