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Abstract

Guillain-Barre syndrome (GBS) is the most common and severe acute immune-mediated paralytic neuropathy. Approximately 30% of patients develop respiratory failure, requiring admission to the intensive care unit (ICU) and invasive mechanical ventilation. The management of disorders concurrent with acute respiratory distress syndrome (ARDS) involves major hurdles. This case report depicts the fast onset of ARDS in a patient with GBS, analyses the utility of the biomarker neurofilament light chain, and highlights the unexpected advantages of proactive ARDS treatments.

Keywords

Guillain-Barre syndrome, Intensive care unit, Acute Respiratory distress syndrome, Intravenous Immunoglobulin, Cerebrospinal fluid.

Introduction

Guillain-Barre syndrome (GBS) is a severe fulminant polyradiculoneuropathy that is caused by an autoimmune condition1. Guillain-Barre syndrome (GBS) is a complicated degenerative neurological disorder which can be acute or chronic in nature2. Guillain-Barre syndrome (GBS) has annual global incidence of approximately 1–2 per 100,000 person/year. GBS is a post-infectious illness caused by either Mycoplasma pneumoniae, Epstein-Barr virus, cytomegalovirus, or Campylobacter jejuni5. GBS occurs more frequently in males than in females and the incidence increases with age, although all age groups can be affected GBS patients usually begin with weakness and sensory symptoms in the legs that spread to the arms and cranial muscles with possible loss of movement and feeling in the legs, arms, upper body and face. While there are a number of different clinical variations and the disease's clinical presentation is varied. Cerebrospinal fluid (CSF), neurological, and electrophysiological tests, as well as the patient's history, are used to diagnose GBS. The cause of Guillain-Barre syndrome (GBS) is unknown, but it's usually triggered by an infection or surgery3,13.  The most prevalent conditions among people with peripheral neuropathy are diabetes mellitus and excessive alcohol consumption along with poor dietary habits2. Natural infection like influenza can potentially trigger Guillain-Barré syndrome, and vaccination has resulted in improving the reduction of complications along with Guillain-Barré syndrome4. There is no cure for Guillain-Barre syndrome, the main purpose of the treatment plan is to help the patient recover and to minimize the severity of the sickness. The management of patients with GBS can be subdivided for the critically paralyzed patient who needs breathing assistance, intensive care, and specialized therapy for reversing the nerve damage which includes High-dose immunoglobulin therapy, Physical therapy, Plasmapheresis3.

Case Study:

A 49-year-old male was admitted to causality with complaints of breathlessness for 2 days and relieves partially on sitting up straight and cough with sputum for 2 days insidious onset. Gradually progressive with whitish sputum and H/O of one episode of fever one day ago, Moderate grade relieved with medications and had H/O 3-4 episodes of vomiting before that day, H/O epigastric pain H/O of fall from 2-wheeler 3 days ago H/O of generalized weakness and constipation since 1 day. He is known case of Type 2 diabetes mellitus, for which he was receiving Tab. Metformin 500 mg. Guillain-barre syndrome was discovered in him. The Ryle’s tube was inserted and he was paralysed. He started to show improvement for the treatment and he couldn’t maintain saturation so patient was incubated on ventilator support. Blood test, cerebrospinal fluid examination, Liver function test, 2D ECHO, coagulation profile, Kidney function test was done. Administration of Ig therapy, IV fluids, Antibiotics, PPI, Multi-vitamins, Antipyretics, Anti-diabetic, Anti- hypertensive, anti-emetic, Expectorant, laxative, Steroids and Bronchodilator as per physician order.

On physical examination, the patient was experienced weakness in the bilateral upper and lower limb, bulbar weakness was present, edema was present. In cardiovascular system S1 & S2 sounds, tachycardia was present. In respiratory system B/L crept were present. In P/A the abdominal region was soft, mild tenderness in right hypochondrium and bowel sounds were heard.

Diagnostic assessment:

Blood test: Hb:12.2g/dl, TLC:3290 /mm3, Platelet count: 0.9 lakh/mm3, Sodium:128mEq/L, PT:12.3 sec, ALP:182 IU/L, Total bilirubin:1.8 mg/dl, Direct Bilirubin: 0.5 mg/dl, SGOT: 83 U/L, CRP:21.3.

In cerebrospinal fluid examination glucose: 137mg/dl, Protein: 386 mg/dl.

In ABG test: PCO2: 50 mmHg, PO2 : 52 mmHg, PH: 6.4

Therapeutic Procedure

Intravenous Immunoglobulin Procedure

A concentrated collection of antibodies is injected into a vein via an infusion pump as part of the IVIG procedure:

  1. A medical practitioner inserts a needle into the patient's arm vein.
  2. The patient receives a gradual infusion of IVIG.
  3. The duration of the infusion may be several hours.

Inj Penitaz 4.5 gm IV 1-1-1 given to treat bacterial infections and to treat community acquired pneumonia Inj Metrogyl 100mg IV 1-1-1 given to treat intraabdominal infection  Inj Nexasome 40 mg IV 1-0-0 given to treat abdominal discomfort

Inj Ondem 4mg IV SOS given to treat vomiting

Inj Thiamine 200mg IV 1-0-1 to treat alcohol withdrawal symptoms Inj Optineuron 1amp in 100 ml normal saline IV 1-0-1 to increase the haemoglobin level  Inj PCT 1 gm IV SOS to treat fever Inj Meropenem 1gm IV 1-1-1 given to treat bacterial infection Inj Insugen R S/C ACC to S/S to treat Type 2DM Inj Globucel (IVIG) 5g 7 per day used to strengthen the body’s natural immune system. Tab Amlong 10mg RT 1-0-1 to treat sodium levels  Tab Prolomet XL 12.5 mg RT 1-0-1 given to treat irregular heart rhythms Tab Pulmoclear 600mg RT 1-0-1 to treat the cough Syp Sucrafil 10ml RT 1-1-1 to treat intestinal ulcers Neb Budecort 1 Resp 1-0-1 to treat wheezing and shortness of breath Neb Mucomix 3Resp 1-1-1 given to loosen thick mucus, making it easier to coughout. The patient bystanders were asked to initiate a physical therapy for the patient to improve the mobility and patient’s overall quality of life. After patient’s symptoms improved, a thorough follow-up plan was provided upon a discharge.

DISCUSSION

This case presents a classic manifestation of Guillain-Barré Syndrome (GBS) in a 49-year-old male with type 2 diabetes mellitus. The patient's presentation with ascending paralysis, respiratory distress, and bulbar weakness represents the typical progression of GBS. The diagnosis was confirmed through cerebrospinal fluid analysis showing albuminocytologic dissociation (elevated protein at 386 mg/dl with normal glucose), a characteristic finding in GBS.

The management approach demonstrated adherence to current treatment guidelines. Intravenous immunoglobulin (IVIG) therapy was promptly initiated, and mechanical ventilation was implemented due to respiratory compromise evidenced by concerning arterial blood gas values (PCO2: 50 mmHg, PO2: 52 mmHg, pH: 6.4). The comprehensive treatment plan included management of complications and comorbidities, particularly the patient's diabetes.

In this case include the rapid progression to respiratory failure requiring ventilatory support and the presence of significant autonomic dysfunction manifesting as tachycardia. The implementation of early physical therapy with family involvement represents an important aspect of care that likely contributed to positive outcomes. The importance of prompt recognition and management of respiratory failure in GBS, the value of comprehensive supportive care alongside immunotherapy, and the significance of early rehabilitation. The successful outcome highlights the effectiveness of a multidisciplinary approach in managing severe GBS, emphasizing the potential for favorable results even in cases with significant complications when appropriate interventions are timely implemented.

CONCLUSION

This case highlights the importance of early recognition and management of GBS, particularly in patients with comorbid conditions like respiratory problems. A multidisciplinary approach, including immunotherapy, ventilatory support, and careful monitoring of organ systems, was crucial in this patient’s management and ongoing recovery. This case emphasizes the need for prompt recognition and aggressive management of GBS, particularly in patients with comorbidities, to optimize outcomes and prevent complications.

REFERENCES

  1. Joshi R, Mendhe D, Wanjari M. Guillain Barre Syndrome: A Case Report and Literature Review. Journal of Pharmaceutical Research International. 2021 Dec 14;33(58A):158-61.
  2. Pikula JR. Guillain-Barre syndrome: a case report. The Journal of the Canadian Chiropractic Association. 1995 Jun;39(2):80.
  3. Pithadia AB, Kakadia N. Guillain-Barré syndrome (GBS). Pharmacological reports. 2010 Mar;62(2):220-32.
  4. Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-barré syndrome. The lancet. 2021 Mar 27;397(10280):1214-28.
  5. Van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, Van Doorn PA. Guillain–Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nature Reviews Neurology. 2014 Aug;10(8):469-82.
  6. Hahn AF. Guillain-barré syndrome. The lancet. 1998 Aug 22;352(9128):635-41.
  7. Hughes RA, Cornblath DR. Guillain-barre syndrome. The Lancet. 2005 Nov 5;366(9497):1653-66.
  8. Vucic S, Kiernan MC, Cornblath DR. Guillain-Barré syndrome: an update. Journal of clinical neuroscience. 2009 Jun 1;16(6):733-41.
  9. Newswanger DL, Warren CR. Guillain-Barré syndrome. American family physician. 2004 May 15;69(10):2405-10.
  10. Donofrio PD. Guillain-Barré Syndrome. CONTINUUM: Lifelong Learning in Neurology. 2017 Oct 1;23(5):1295-309.
  11. Streatment of Guillain-Barré syndrome. The Lancet Neurology. 2008 Oct 1;7(10):939-50.
  12. Willison HJ, Jacobs BC, van Doorn PA. Guillain-barre syndrome. The Lancet. 2016 Aug 13;388(10045):717-27.
  13. Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR et.al,. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019 Nov;15(11):671-683. doi: 10.1038/s41582-019-0250-9.  
  14. Zifko U, Chen R, Remtulla H, Hahn AF, Koopman W, Bolton CF. Respiratory electrophysiological studies in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry. 1996 Feb;60(2):191-4. doi: 10.1136/jnnp.60.2.191

Reference

  1. Joshi R, Mendhe D, Wanjari M. Guillain Barre Syndrome: A Case Report and Literature Review. Journal of Pharmaceutical Research International. 2021 Dec 14;33(58A):158-61.
  2. Pikula JR. Guillain-Barre syndrome: a case report. The Journal of the Canadian Chiropractic Association. 1995 Jun;39(2):80.
  3. Pithadia AB, Kakadia N. Guillain-Barré syndrome (GBS). Pharmacological reports. 2010 Mar;62(2):220-32.
  4. Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-barré syndrome. The lancet. 2021 Mar 27;397(10280):1214-28.
  5. Van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, Van Doorn PA. Guillain–Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nature Reviews Neurology. 2014 Aug;10(8):469-82.
  6. Hahn AF. Guillain-barré syndrome. The lancet. 1998 Aug 22;352(9128):635-41.
  7. Hughes RA, Cornblath DR. Guillain-barre syndrome. The Lancet. 2005 Nov 5;366(9497):1653-66.
  8. Vucic S, Kiernan MC, Cornblath DR. Guillain-Barré syndrome: an update. Journal of clinical neuroscience. 2009 Jun 1;16(6):733-41.
  9. Newswanger DL, Warren CR. Guillain-Barré syndrome. American family physician. 2004 May 15;69(10):2405-10.
  10. Donofrio PD. Guillain-Barré Syndrome. CONTINUUM: Lifelong Learning in Neurology. 2017 Oct 1;23(5):1295-309.
  11. Streatment of Guillain-Barré syndrome. The Lancet Neurology. 2008 Oct 1;7(10):939-50.
  12. Willison HJ, Jacobs BC, van Doorn PA. Guillain-barre syndrome. The Lancet. 2016 Aug 13;388(10045):717-27.
  13. Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR et.al,. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019 Nov;15(11):671-683. doi: 10.1038/s41582-019-0250-9.  
  14. Zifko U, Chen R, Remtulla H, Hahn AF, Koopman W, Bolton CF. Respiratory electrophysiological studies in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry. 1996 Feb;60(2):191-4. doi: 10.1136/jnnp.60.2.191

Photo
S. Jabeen Taj
Corresponding author

Bapuji Pharmacy College, Davangere, Karnataka

Photo
Harshith M. Pisale
Co-author

Bapuji Pharmacy College, Davangere, Karnataka

Photo
Aswan Kumar Reddy K. V.
Co-author

Bapuji Pharmacy College, Davangere, Karnataka

Photo
Sandeep Jadhav
Co-author

Bapuji Pharmacy College, Davangere, Karnataka

Photo
Amrutha Varshini R.
Co-author

Bapuji Pharmacy College, Davangere, Karnataka

S. Jabeen Taj*, Harshith M. Pisale, Aswan Kumar Reddy K. V., Sandeep Jadhav, Amrutha Varshini R., Acute Respiratory Distress Syndrome with Guillain Barre Syndrome, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 1, 1637-1640. https://doi.org/10.5281/zenodo.14691560

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