Case study 1: Manuel—Increasing weakness
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A 24-year-old man presents to his primary care provider with his mother for an urgent appointment due to increasing weakness during the past week. The patient says he had a “stomach bug” two weeks ago after attending an outdoor BBQ, and initially attributed his weakness to that. However, instead of getting better, the weakness is getting worse. He says he is having difficulty walking and cannot stand for more than a few minutes at a time. It is challenging to hold a glass of water or utensils during meals. His mother is very worried and wants to know if he should go to the ER.
question
Which of the following is a rare, but potentially life-threatening complication of his current condition?
The patient is presenting with what is likely Guillain-Barré syndrome, owing to a prior infection with Campylobacter jejuni. While it is rare, certain patients can develop respiratory failure and require mechanical ventilation. It will be important to monitor this patient carefully.
- Post-infectious acute inflammatory neuropathy believed to be caused by molecular mimicry.
- Strongly associated with preceding diarrheal illness due to Campylobacter jejuni, however other infections have been implicated.
- Occasionally also seen following vaccination.
- Acute-onset, symmetric ascending flaccid paralysis.
- Monophasic: Very rarely presents with relapsing-remitting course.
- May involve respiratory muscles life-threatening; requires mechanical ventilation.
- Generally a clinical diagnosis.
- Nerve-conduction studies can differentiate from other forms of neuropathy.
- CSF is of limited utility; elevated protein with normal WBC.
- MRI may show increased enhancement at nerve roots.
- Depending on severity, consider IVIG or plasma exchange.
- Significant risk of autonomic instability: Admission for cardiac/respiratory monitoring during progression of symptoms is required.
- Intubation and mechanical ventilation may be required if respiratory compromise present (~30%).
- Avoid steroids!
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