{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:06:44Z","timestamp":1756339604720,"version":"3.44.0"},"reference-count":33,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,8,8]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>Various disorders can cause acute onset ataxia including those that have toxic\/metabolic, traumatic, neoplastic, vascular, demyelinating\/dysmyelinating, infectious, postinfectious and genetic features. We present a case of postseptic acute ataxia. A 72-year-old woman was diagnosed with septic shock secondary to acute obstructive suppurative cholangitis. A blood sample for bacterial culture was positive for <jats:italic>Klebsiella pneumoniae<\/jats:italic>. Thus, we initiated antibiotics and intravenous immunoglobulin therapies to control the infection. We later added extracorporeal endotoxin removal with a polymyxin B immobilised fibre cartridge for endotoxin shock. The patient\u2019s condition improved soon after endotoxin removal. Mildly slurred and explosive speech with limb and truncal ataxia, which improved gradually, developed shortly afterwards. Serum samples obtained on day 15 after admission were positive for anti-GD1b IgG antibody. The clinical course of monophasic illness with good recovery, neurological findings and the appearance of anti-GD1b antibody suggest that this case is a variant of Miller-Fisher syndrome.<\/jats:p>","DOI":"10.1136\/bcr-2021-242396","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T12:20:54Z","timestamp":1629462054000},"page":"e242396","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Case of acute onset ataxia caused by <i>Klebsiella pneumoniae<\/i> sepsis with the appearance of anti-GD1b antibody"],"prefix":"10.1136","volume":"14","author":[{"given":"Shigeo","family":"Yamada","sequence":"first","affiliation":[{"name":"Neurology, JCHO Tokyo Shinjuku Medical Center, Shinjuku-ku, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Umeya","sequence":"additional","affiliation":[{"name":"General Medicine, Ama Municipal Hospital, Ama-shi, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"2025082711390836000_14.8.e242396.1","unstructured":"Japanese Society of Neurology guideline for diagnosis and treatment of Guillain-Barr\u00e9 syndrome, 2013. Available: https:\/\/neurology-jp.org\/guidelinem\/gbs\/sinkei_gbs_2013_02.pdf [Accessed 05 July 2021]."},{"key":"2025082711390836000_14.8.e242396.2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2014.138"},{"key":"2025082711390836000_14.8.e242396.3","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s00101-008-1471-2","article-title":"[Sepsis-associated Guillain-Barr\u00e9 syndrome]","volume":"58","author":"Rehberg","year":"2009","journal-title":"Anaesthesist"},{"key":"2025082711390836000_14.8.e242396.4","first-page":"349","article-title":"Campylobacter jejuni bacteremia and Guillain-Barr\u00e9 syndrome in a patient with GVHD after allogeneic BMT","volume":"13","author":"Hagensee","year":"1994","journal-title":"Bone Marrow Transplant"},{"key":"2025082711390836000_14.8.e242396.5","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1007\/s10072-011-0823-x","article-title":"Guillain-Barr\u00e9 syndrome following sepsis after stereotactic aspiration for spontaneous pontine hemorrhage","volume":"33","author":"Song","year":"2012","journal-title":"Neurol Sci"},{"key":"2025082711390836000_14.8.e242396.6","doi-asserted-by":"publisher","DOI":"10.1007\/s001470050171"},{"key":"2025082711390836000_14.8.e242396.7","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1007\/s004150170212","article-title":"Acute motor axonal Guillain-Barr\u00e9 syndrome after Salmonella typhimurium bacteremia and Cryptococcal meningitis in AIDS","volume":"248","author":"Blanche","year":"2001","journal-title":"J Neurol"},{"key":"2025082711390836000_14.8.e242396.8","doi-asserted-by":"crossref","first-page":"589","DOI":"10.2169\/internalmedicine.46.6330","article-title":"Rapidly progressive Guillain-Barr\u00e9 syndrome following Escherichia coli infection","volume":"46","author":"Kono","year":"2007","journal-title":"Intern Med"},{"key":"2025082711390836000_14.8.e242396.9","doi-asserted-by":"crossref","first-page":"491","DOI":"10.3109\/10731199009119623","article-title":"Novel endotoxin adsorbing materials, polymyxin-sepharose and polyporous polyethylene membrane for removal of endotoxin from dialysis systems","volume":"18","author":"Umeda","year":"1990","journal-title":"Biomater Artif Cells Artif Organs"},{"key":"2025082711390836000_14.8.e242396.10","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410350510"},{"key":"2025082711390836000_14.8.e242396.11","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/B978-0-444-64189-2.00021-4","article-title":"Immune-mediated ataxias","volume":"155","author":"Joubert","year":"2018","journal-title":"Handb Clin Neurol"},{"key":"2025082711390836000_14.8.e242396.12","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-019-0250-9"},{"key":"2025082711390836000_14.8.e242396.13","doi-asserted-by":"publisher","DOI":"10.1097\/00005072-196204000-00001"},{"key":"2025082711390836000_14.8.e242396.14","first-page":"527","article-title":"[Guillain-Barr\u00e9 syndrome with cerebellar symptoms and elevated serum anti-GD1b IgG antibody]","volume":"39","author":"Araki","year":"1999","journal-title":"Rinsho Shinkeigaku"},{"key":"2025082711390836000_14.8.e242396.15","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.69.1.136"},{"key":"2025082711390836000_14.8.e242396.16","first-page":"523","article-title":"[Ataxic form of Guillain-Barr\u00e9 syndrome associated with anti-GD1b IgG antibody]","volume":"41","author":"Ichikawa","year":"2001","journal-title":"Rinsho Shinkeigaku"},{"key":"2025082711390836000_14.8.e242396.17","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410390404"},{"key":"2025082711390836000_14.8.e242396.18","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/jns.12104","article-title":"Cytoalbuminologic dissociation in asian patients with Guillain-Barr\u00e9 and Miller Fisher syndromes","volume":"20","author":"Wong","year":"2015","journal-title":"J Peripher Nerv Syst"},{"key":"2025082711390836000_14.8.e242396.19","doi-asserted-by":"publisher","DOI":"10.2183\/pjab.88.299"},{"key":"2025082711390836000_14.8.e242396.20","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0000000000000042"},{"key":"2025082711390836000_14.8.e242396.21","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1111\/j.1348-0421.1999.tb02472.x","article-title":"Production of murine collagen-induced arthritis using Klebsiella pneumoniae O3 lipopolysaccharide as a potent immunological adjuvant","volume":"43","author":"Takahashi","year":"1999","journal-title":"Microbiol Immunol"},{"key":"2025082711390836000_14.8.e242396.22","doi-asserted-by":"publisher","DOI":"10.1016\/0161-5890(94)90074-4"},{"key":"2025082711390836000_14.8.e242396.23","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-4159.2010.07029.x"},{"key":"2025082711390836000_14.8.e242396.24","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20222"},{"key":"2025082711390836000_14.8.e242396.25","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2007.142950"},{"key":"2025082711390836000_14.8.e242396.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2006.09.013"},{"key":"2025082711390836000_14.8.e242396.27","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2006.087940"},{"key":"2025082711390836000_14.8.e242396.28","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1007\/s00415-014-7388-6","article-title":"GD1b-specific antibodies may bind to complex of GQ1b and GM1, causing ataxia","volume":"261","author":"Yuki","year":"2014","journal-title":"J Neurol"},{"key":"2025082711390836000_14.8.e242396.29","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1007\/s00415-020-10219-5","article-title":"A rare case of acute motor axonal neuropathy and myelitis related to SARS-CoV-2 infection","volume":"268","author":"Masuccio","year":"2021","journal-title":"J Neurol"},{"key":"2025082711390836000_14.8.e242396.30","doi-asserted-by":"crossref","first-page":"e601","DOI":"10.1212\/WNL.0000000000009619","article-title":"Miller Fisher syndrome and polyneuritis cranialis in COVID-19","volume":"95","author":"Guti\u00e9rrez-Ortiz","year":"2020","journal-title":"Neurology"},{"key":"2025082711390836000_14.8.e242396.31","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1007\/s00415-020-10108-x","article-title":"Immune-Mediated neurological syndromes in SARS-CoV-2-infected patients","volume":"268","author":"Guilmot","year":"2021","journal-title":"J Neurol"},{"key":"2025082711390836000_14.8.e242396.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2020.105960"},{"key":"2025082711390836000_14.8.e242396.33","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000781"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-242396","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:39:13Z","timestamp":1756319953000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-242396"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":33,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,20]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bcr-2021-242396"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-242396","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}