Differential Diagnosis for Elevated Creatine Kinase in a Patient with Diarrhea and Sudden Paraplegia

• Single Most Likely Diagnosis
  • Guillain-Barré Syndrome (GBS): This is a likely diagnosis given the sudden onset of paraplegia following a gastrointestinal infection (diarrhea), which can trigger an immune response leading to GBS. Elevated creatine kinase (CK) levels can be seen due to muscle involvement.
• Other Likely Diagnoses
  • Spinal Cord Infarction: Although less common, a spinal cord infarction could present with sudden paraplegia. The elevated CK could be related to muscle damage from the paralysis rather than the primary cause.
  • Transverse Myelitis: An inflammatory condition affecting the spinal cord, which could be triggered by an infection. It presents with rapid onset of neurological symptoms, including paralysis, and could have elevated CK due to muscle spasms or damage.
• Do Not Miss Diagnoses
  • Spinal Epidural Abscess: A serious condition that requires immediate attention. While less likely, it can present with sudden neurological deficits, including paralysis, and back pain. The elevated CK might not be directly related but could be seen in the context of systemic infection.
  • Spinal Cord Compression (e.g., from a tumor or hematoma): This is a medical emergency that could present with sudden paralysis. Elevated CK might be seen due to muscle injury from the compression.
• Rare Diagnoses
  • Poliomyelitis: Although rare in areas with good vaccination coverage, polio can cause acute flaccid paralysis following a gastrointestinal infection. Elevated CK could be seen due to muscle involvement.
  • Tick Paralysis: Caused by a neurotoxin in the saliva of certain ticks, this condition can lead to ascending paralysis. It's rare and typically associated with the presence of an attached tick, but it's a consideration in the right epidemiological context.
  • Botulism: Can cause descending paralysis but is less likely to present with elevated CK levels as it primarily affects the neuromuscular junction without causing significant muscle damage.