When Guillain–Barré Syndrome Defies Expectations: A Case of Atypical Features

• Published in: Indian journal of medical specialities 2024-10, Vol.15 (4), p.279-282
• Main Authors: Khan, Ulma, Pandit, Sanjay, Chawla, Kishore, Golani, Mahak, Dharra, Gaurav, Aggarwal, Rupal
• Format: Article
• Language: English
• Subjects: Encephalitis; Miller Fisher syndrome; Paralysis
• ISSN: 0976-2884; 0976-2892
• DOI: 10.4103/injms.injms_65_24

Guillain–Barré syndrome (GBS) is one of the most common causes of acute flaccid paralysis. In typical GBS, there are no central nervous system (CNS) features. GBS with prominent CNS involvement can be seen in uncommon variants of GBS (such as Miller Fisher Syndrome and Bickerstaff brainstem encephalitis [BBE]) or rarely, when it coexists with other conditions such as acute disseminated encephalomyelitis (ADEM). We report a case of a 35-year-old male who presented with fever followed by ascending lower motor neuron type paraparesis suggestive of GBS which progressed rapidly to involve the respiratory muscles necessitating invasive mechanical ventilation. The patient had many atypical features, namely, persistent fever, early bladder and bowel involvement, facial twitching, ophthalmoplegia with ptosis, and a comatose state. Based on these clinical features and the investigations done, a diagnosis of GBS with BBE with a possibility of ADEM was made. The patient was managed intensively, but there was no improvement in the neurological manifestations and the patient succumbed to the illness due to ventilator-associated complications.