Ultra-early perioperative Guillain–Barré syndrome following traumatic fracture surgery: a case report and literature review

Guillain–Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy most commonly associated with preceding infection. Perioperative GBS is rare, particularly when neurological symptoms develop within 24 h after surgery. We report a 46-year-old man who developed rapidly progressive symmetrical limb weakness and sensory symptoms approximately 15 h after surgical fixation of traumatic fractures, including a right intertrochanteric femur fracture and a right calcaneal fracture. His neurological condition rapidly progressed to bulbar dysfunction, respiratory failure, and cardiac arrest. Electrophysiological examination revealed motor and sensory peripheral nerve abnormalities with mixed demyelinating and axonal features, supporting a clinical diagnosis of GBS, although definitive electrophysiological subtype classification was not possible. Cerebrospinal fluid analysis was not performed because the family declined lumbar puncture due to concerns about bleeding risk during postoperative anticoagulation, limiting diagnostic certainty. Intravenous immunoglobulin (IVIG) therapy was initiated following clinical suspicion of GBS, alongside respiratory support and comprehensive rehabilitation. At transfer to a higher-level hospital, the patient remained severely neurologically impaired. According to information provided by the patient during a telephone follow-up approximately six months later, outpatient assessment at the receiving hospital indicated substantial neurological recovery, including independent ambulation and recovery of swallowing and bowel and bladder function; these findings were not independently verified by the authors. Although GBS developed shortly after trauma and surgery, a causal relationship between these events and the syndrome could not be established. This case highlights the diagnostic challenges of very early postoperative GBS and underscores the importance of prompt recognition, appropriate electrophysiological evaluation, and timely consideration of immunotherapy in patients with unexplained progressive postoperative weakness.