Fulminant Guillain-Barré Syndrome (GBS) with a Constellation of Uncommon Clinical Manifestations: Differential Diagnosis and Treatment Challenges

Abstract

Background: Fulminant Guillain-Barré syndrome (GBS) could present with myriad of clinical findings requiring an aggressive, yet under-investigated, treatment for case resolution. Case Report: We herein discuss a case of fulminant Guillain-Barré syndrome (GBS) in a previously healthy 25-year-old female patient presenting for ascending limb weakness and paraesthesia. The nerve conduction studies (NCS) and electromyography (EMG) with the magnetic resonance imaging (MRI) of the spinal cord were all consistent with a diagnosis of GBS. The patient gradually developed quadriplegia and facial diplegia despite treatment. In addition, she had severe sensory disturbances that consisted mainly of paraesthesia, dysesthesias, neuropathic pain and anaesthesia. Few days later she developed type II respiratory failure, requiring urgent intubation and intensive care unit (ICU) transfer despite treatment. Moreover, she had autonomic dysfunction consisting of tachycardia and bradycardia, nausea, urine and fecal incontinence as well as diaphoresis and syndrome of inappropriate antidiuretic hormone secretion (SIADH). Conclusion: In view of the severe clinical course of this disease, the patient was initially treated with two cycles of intravenous IgG immunoglobulin (IVIG) administration followed by five sessions of plasmapheresis. Marked clinical improvement was noticed after the 4 th session of plasmapheresis.