Bilateral Claw Hand in Pediatric Guillain Barré Syndrome

To the Editor: A 10-y-old developmentally normal girl presented with difficulty extending the little and ring fingers of both hands for 5 d (Supplementary Fig. S1). By the third day, she experienced calf pain and had difficulty rising from the floor by the fourth day. The condition did not progress further. She remained ambulatory without trunk, neck, bulbar, or respiratory muscle weakness. There were no signs of altered sensorium, seizures, abnormal movements, sensory abnormalities, or bowel/bladder dysfunction. A preceding upper respiratory infection one-month prior had resolved with symptomatic treatment. Examination showed stable vitals, Neurological assessment revealed bilateral clawing of the fourth and fifth digits, and poor hand grip. Muscle power was graded 4/5 in bilateral finger flexors and extensors, with normal power in other joints. Deep tendon reflexes were absent; plantar reflex was flexor bilaterally. CSF examination on fifth day of symptom onset was normal. Nerve conduction studies (NCS) indicated acute motor axonal polyneuropathy (AMAN). Antinuclear antibody (ANA) test was negative, but serum anti-GM1 antibodies were positive. MRI cervical spine was normal. The patient received intravenous immunoglobulin therapy (2 g/kg), leading to a gradual recovery. At 2-wk follow-up, there was no residual proximal girdle weakness, and significant improvement in clawing was noted, with both finger extensor and flexor power returning to 5/5. …