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Abstract：
Despite being extremely rare, Guillain-Barré syndrome (GBS) has been recognized as a neurological complication of multiple myeloma, with variable responses to plasmapheresis (PEX), intravenous immunoglobulins (IVIG), and anti-myeloma therapies. In this paper, we report a case of a female patient with asymptomatic multiple myeloma (aMM) who initially presented as PEX- and IVIG-refractory GBS. After failure of PEX, IVIG, and anti-myeloma therapy (bortezomib, melphalan, and prednisone), the patient was eventually successfully treated with low-dose rituximab (100 mg/m2 per week in four doses). To the best of our knowledge, this is the first case to report successful treatment of refractory GBS potentially associated to aMM with low-dose rituximab. Additional studies are needed to elucidate the pathophysiological processes and the interplay between the dysregulated immune response, monoclonal immunoglobulin (MG), and neural tissue damage in GBS patients. Also, the potential role of rituximab in the treatment of MG-associated GBS warrants further exploration.
摘要：
尽管非常罕见，格林-巴利综合征（GBS）已被认为是多发性骨髓瘤的神经系统并发症，对血浆置换（PEX）的反应不同，静脉注射免疫球蛋白（IVIG），和抗骨髓瘤治疗。在本文中,我们报道一例无症状多发性骨髓瘤(aMM)女性患者,最初表现为PEX-和IVIG-难治性GBS.PEX失效后,IVIG,和抗骨髓瘤治疗(硼替佐米，melphalan,和泼尼松)，患者最终成功接受了低剂量利妥昔单抗(每周100mg/m2,共4剂)治疗.据我们所知,这是首例报道低剂量利妥昔单抗成功治疗aMM相关难治性GBS的病例.需要进一步的研究来阐明病理生理过程以及失调的免疫反应之间的相互作用。单克隆免疫球蛋白（MG），GBS患者的神经组织损伤。此外，利妥昔单抗在MG相关GBS治疗中的潜在作用值得进一步探索.
