Recurrence of Guillain-Barre syndrome: a case report

Abstract

Introduction: Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy preceded by infections in up to 60% of cases. The incidence of GBS is 1-2 cases per 100,000 people per year, with a 20% increase with each decade of age. The recurrence rate is estimated at 5%, making it a rare event. Analysis: The patient presented with initial symptoms suggestive of a respiratory infection, but progression to paresthesias and severe limb weakness, along with areflexia, raised suspicion of recurrent GBS. The diagnosis was confirmed clinically using the Brighton criteria, supported by neurophysiological studies. The severity (GBS-DS 3) warranted urgent hospital admission. Case Outcome: The patient was treated with intravenous immunoglobulin (IVIG) at a dose of 0.4 g/kg/day for 3 days, along with analgesics for neuropathic pain and early physical therapy. The patient was subsequently discharged to an outpatient rehabilitation program. At 3 months of follow-up, the patient achieved complete remission, similar to his first episode. Discussion: This case highlights the rarity of GBS recurrence and its association with respiratory infections. Although the absence of a lumbar puncture limits complete diagnostic confirmation, neurophysiological studies and treatment response support the diagnosis. The choice of IVIG was appropriate according to current guidelines, and clinical improvement without the use of corticosteroids reinforces the evidence that these are not recommended for GBS.