Guillain-Barré syndrome complicated by acute flaccid tetraplegia: a clinical case

Abstract

Introduction. Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy characterized by autoimmune damage to peripheral nerve myelin sheaths or axons. Its clinical significance is driven by the risk of rapid ascending paralysis, respiratory failure, and high disability rates (20–30%). In pediatrics, diagnosis is often challenged by atypical presentation, particularly a severe pain syndrome mimicking somatic conditions.

Aim. This study aims to analyze the diagnostic and management characteristics of a 5-year-old patient with rapidly progressive GBS within 48 hours, complicated by acute flaccid tetraplegia.

Materials and Methods. The clinical case of a 5-year-old patient with rapidly progressive Guillain-Barré syndrome was analyzed. The diagnostic assessment included evaluation of clinical neurological findings, cerebrospinal fluid analysis, and electroneuromyography (ENMG).

Results. The case presented with acute, severe muscle pain, leading to an initial misdiagnosis of generalized myositis and an 11-day delay in specific immunotherapy. The diagnosis was established based on clinical findings, including total areflexia and flaccid tetraplegia, and ENMG signs of acute inflammatory demyelinating polyradiculoneuropathy. Early cerebrospinal fluid analysis did not reveal classic albuminocytological dissociation, which did not contradict the diagnosis at the early stages. The primary specific treatment consisted of intravenous immunoglobulin (IVIG) at a total dose of 2 g/kg. Glucocorticoids were administered as a short pulse course solely for managing severe refractory pain and systemic inflammatory response. Comprehensive therapy and intensive care monitoring led to significant clinical improvement: the patient regained the ability to sit independently and walk with support.

Conclusions. This case emphasizes the critical need for prompt neurological evaluation in children presenting with acute limb pain and highlights the high efficacy of IVIG.