Successful Management of Fulminant Guillain-Barré Syndrome and Its Complications

Abstract

A 3-year-old girl presented with muscle weakness of her limbs and trunk 6 days after developing symptoms of common cold. Two days later, she experienced respiratory arrest with a Glasgow Coma Scale score of 3, necessitating endotracheal intubation. Therefore, she was transferred to our hospital with suspected acute encephalopathy. Although no abnormalities were observed on brain and spinal magnetic resonance imaging and electroencephalography, peripheral nerve conduction velocity tests failed to evoke motor and sensory nerve action potentials. Thus, we gave a diagnosis of fulminant Guillain-Barré syndrome and initiated immunoglobulin therapy. On day 3 of admission, she developed sinus tachycardia that induced circulatory failure and oliguria, which was successfully treated with landiolol. Subsequently, we performed plasmapheresis followed by immunoglobulin and steroid pulse therapies. She was weaned off the mechanical ventilator by day 20 of admission, was ambulatory by day 44, and had completely recovered without any adverse sequelae by day 55. In conclusion, landiolol was effective for treating acute sinus tachycardia-induced circulatory failure and played a key role in saving the life of this patient.

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“…27 There are not many studies, particularly in children, where both PLEX and IgIV are used simultaneously. In one of the few early articles 47 there were no significant differences between using each technique alone or in combination. However, in fulminant GBS, the combination of both immunological therapies and supportive treatment are essential.…”

“…However, in fulminant GBS, the combination of both immunological therapies and supportive treatment are essential. [47][48][49] In 2019, an innovative approach was published, using both therapies intercalated. 29 In this study, patients had better results in every parameter, when comparing with each therapy alone.…”

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

“…This concept seems to be challenged in cases of severe fulminant GBS such as this case. Kamei A et al discussed a case of paediatric fulminant GBS which did not resolve prior to the initiation of plasmapheresis which was then followed by IVIG administration [11]. The same problem was presented by Revathy et al who discussed a case of fulminant GBS in a 56-year-old male refractory to IVIG which required 14 sessions of plasma exchange [12].…”

Immunotherapy in Pediatric Guillain-Barré Syndrome: Intravenous Immunoglobulin, Plasmapheresis, Both or Something Else?

“…However, in fulminant GBS, the combination of both immunological therapies and supportive treatment are essential. [47][48][49] In 2019, an innovative approach was published, using both therapies intercalated. 29 In this study, patients had better results in every parameter, when comparing with each therapy alone.…”