Letters to the Editor A case of Guillain–Barré syndrome following prosthetic valve endocarditis Turgay Celik a, ⁎ , Atila Iyisoy a , Murat Celik a , Oben Baysan a , Semai Bek b , M. Tolga Dogru c a Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik-Ankara, Turkey b Gulhane Military Medical Academy, School of Medicine, Department of Neurology, Etlik-Ankara, Turkey c Kirikkale University, School of Medicine, Department of Cardiology, Kirikkale, Turkey Received 4 June 2007; accepted 1 July 2007 Available online 17 October 2007 Abstract Guillain–Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy associated with progressive limb weakness and areflexia. Up to now, a few cases of GBS following infective endocarditis (IE), particularly prosthetic valve endocarditis, have been reported. We present a case of a 63-year-old male patient in whom GBS developed following aortic prosthetic valve endocarditis. Although GBS is not frequently encountered in patients with IE, we believe that every clinician should consider the probable GBS in those patients suffering from distal paresthesis, progressive limb weakness and ataxia. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Guillain–Barré syndrome; Prosthetic valve endocarditis; Aortic valve disease In their recently published manuscript, Baravelli and cow- orkers reported a case of 74-year-old man with Guillain–Barré syndrome (GBS) following Staphylococcus aureus endocarditis affecting aortic valve [1]. A 63-year-old male patient , who underwent aortic valve replacement (AVR, St. Jude) and coronary artery bypass surgery for triple vessel disease 2 months ago, was admitted to our outpatient clinic with the symptoms of general malaise, weight loss and dyspnea on exertion. On initial physical examination, he had low grade pyrexia and conjunctival hemorrhages. Heart rate and arterial blood pressure values were 112 bpm and 130/80 mmHg, respectively. On cardiac auscul- tation, 2/6 grade midsystolic ejection murmur in combina- tion with sharp closing sound was heard at the second right parasternal area. Respiratory system was otherwise normal. Resting electrocardiogram revealed that left ventricular hypertrophy with systolic overload pattern. Transthoracic echocardiography showed; mildly dilated left ventricle associated with global hypokinesis (left ventricular ejection fraction of 25%), metallic prosthetic valve on aortic position with 20 mmHg peak systolic gradient and mild paravalvuler aortic regurgitation. Subsequently performed transesophageal echocardiography revealed a dilated aortic root with moderate aortic regurgitation and ‘boggy’ area around AVR consistent with infective endocarditis (IE) (Fig. 1A and B). Three sets of blood cultures were with- drawn at 3 different venipuncture sites in 3 different occa- sions. No etiologic agent was isolated from blood cultures. Prolonged incubation of up to 21 days revealed no specific agent for infective endocarditis. The initial laboratory tests revealed normocytic anemia, elevated serum erythrocyte International Journal of Cardiology 133 (2009) 102 – 139 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Department of Cardiology, Gulhane School of Medicine, 06018 Etlik-Ankara, Turkey. Tel.: +90 312 3044268; fax: +90 312 3044250. E-mail address: benturgay@yahoo.com (T. Celik).