In a study by Nagashima et al, 27% of the individuals with PCB variant GBS required endotracheal intubation.13 PCB variant is often misdiagnosed with brainstem stroke or myasthenia gravis. mosquitoes, the same vectors for dengue fever.1 Multiple outbreaks of CHIK fever have occurred in Asia and Africa in the last two decades affecting millions. 2 CHIK fever typically presents with fever, severe arthralgias, myalgias and skin rash. Atypical FD-IN-1 presentations with myocarditis, hepatitis and meningoencephalitis may also happen.3 Instances of transverse myelitis and Guillain-Barr syndrome (GBS) secondary to CHIK fever have been reported.4C6 Although these instances are rare, with frequent outbreaks of CHIK fever, they may be increasingly becoming seen in clinical practice. Recognition of various neurological complications is definitely important. We are reporting a case of a rare variant of GBS, the pharyngealCcervicalCbrachial (PCB), secondarily to a CHIK illness. Case demonstration A 36-year-old female offered to us having a 3-day time history of difficulty swallowing followed by weakness in her FD-IN-1 left arm for 1?day time. She experienced difficulty in swallowing both liquids and solids. It was progressive and associated FD-IN-1 with nose regurgitation, voice changes and drooling of saliva. Her symptoms were continuous without a diurnal variance. The remaining?arm weakness was noticed about awakening 1?day time ago and was progressive. She refused symptoms of sore throat, fever, headache, neck pain, double vision, facial or limb sensory disturbances and hearing problems associated with her current symptoms. Four weeks prior to this admission, she experienced experienced low-grade fever, generalised body aches and moderate pain in her bones, with FD-IN-1 predominant involvement of knees, shoulders and ankle joints. Fever subsided within VCL the next 5C6 days; however, the joint aches and pains persisted although the severity had decreased. She was diagnosed with having?CHIK viral fever about clinical grounds and was taking analgesics about as per needed basis. There was no history FD-IN-1 of chronic ailments. On physical exam, she was vitally stable, awake and oriented with undamaged higher mental functions. Extraocular movements were intact in all directions without nystagmus. She experienced a hypernasal conversation. Pupils were bilaterally 3? mm equivalent and reactive to light and accommodation. She experienced a right-sided facial palsy of lower engine neuron type. Facial sensation was undamaged. Gag?reflex was weak and uvula was deviated to the left part. Tongue was central on protrusion with no fasciculations. On engine examination, muscle mass bulk and firmness were normal. Power in remaining top limb was reduced.?Medical Study Council (MRC) grade was 3/5 proximally and 4/5 distally with reduced deep tendon reflexes, while power and reflexes in the remaining limbs were normal. Sensory and cerebellar exam was normal. Investigations A baseline workup, including total blood counts, serum electrolytes and thyroid profile, was unremarkable. IgM antibodies against CHIK?disease were detected. She underwent MRI of the brain (on day time 1) which did not reveal any acute abnormalities. Cerebrospinal fluid (CSF)?exam (on day time 2) was normal with no albuminocytological dissociation. On the same day time (day time 2), nerve conduction studies with electromyography (EMG) exposed nonspecific findings, with prolongation of bilateral R1, R2 and contralateral R2 latencies on blink screening. On EMG, voluntary engine unit action potentials had normal morphology with decreased recruitment and a rapid firing rate. In the medical setting, they were suggestive of an early neurogenic process, probably demyelinating in nature and a analysis of the PCB?variant of GBS?was made. Screening for antiganglioside antibodies (IgG anti-GT1a antibodies) is not available which was a limitation for definitive analysis. Differential diagnosis Due to right-sided facial weakness, bulbar symptoms and left-sided engine weakness, our provisional analysis was of a posterior blood circulation stroke involving the mind stem. The additional differentials were GBS, botulism, myasthenia gravis, postviral autoimmune demyelination or multiple sclerosis. Treatment Treatment with intravenous immunoglobulin (IVIG) was started on the second day time of admission for a total of 5 days (total dose of 2?g/kg). On the same day time (day time 2), she became tachypneic having a respiratory rate of 34 breaths/min, and reduction of.