A case of atypical complication of severe leptospirosis as Guillain-Barre syndrome

Neurological complications in Leptospirosis are rare, and may manifest early and late also. We present atypical delayed neurological complication of Leptospira as Guillain Barre Syndrome. A 51 year old diabetic presented with high-grade intermittent fever with chills associated with shortness of breath, vomiting and diarrhea, and reduced urinary output. His septic shock and severe sepsis caused lead to acute kidney injury, hepatitis, and left ventricular dysfunction. On investigation Leptospiral IgM antibodies was positive. He was managed with antibiotics, continues reno-replacement therapy, and mechanical ventilation support. Following his recovery from Leptospira-related systemic problems, he developed quadriparesis with truncal weakness and areflexia without sensory involvement. Nerve conduction study suggested polyneuropathy involving bilateral upper and lower limbs with sparing of sural nerve and impersistent F wave. He was diagnosed with Guillain Barre Syndrome and was treated with Immunoglobulins 150 grams over the course of five days. He improved and gained independence in all spheres of life. Leptospirosis is a potentially serious illness, often results in multi-organ failure and necessitates ICU admission. Initial signs and symptoms and routine laboratory investigations can be nonspecific. Because neurological problems are uncommon and often take time to show, it is imperative to monitor these individuals.