Abstract Introduction Guillain-Barré Syndrome (GBS), also known as acute inflammatory demyelinating polyradiculoneuropathy, is a rare autoimmune disorder in which the body’s immune system mistakenly attacks the peripheral nerves, leading to weakness, numbness, and paralysis. We present a case of GBS in an elderly man who initially presented with a lower respiratory tract infection requiring intubation and experienced a rapid neurological decline, initially suspected to be an acute stroke. Case Presentation A 74-year-old Caucasian male with a history of insulin-dependent type 2 diabetes mellitus, diabetic neuropathy, and atrial fibrillation on apixaban presented with a one-week history of worsening shortness of breath and cough. Four days prior to admission, he experienced numbness and weakness in both lower legs, which he attributed to his diabetic neuropathy. Upon admission, he was diagnosed with septic shock secondary to community-acquired pneumonia and required intubation due to acute respiratory failure. While being off sedation, the patient was noted to have bilateral lower leg paraplegia. Given the initial concern for stroke, a CT scan and cervical MRI were obtained, but both showed no acute abnormalities. Over the course of his ICU stay, he developed progressive ascending flaccid paralysis, eventually becoming quadriplegic with sensory loss and inability to move his shoulders. With persistent progressive neurological deficits, GBS was considered. A lumbar puncture was performed, and IVIG therapy was initiated empirically. Cerebrospinal fluid analysis revealed elevated protein (85.1 mg/dL) with a normal white blood cell count (6/mm³), consistent with albuminocytologic dissociation. GM1 IgG and IgM antibodies were detected. Despite completing a 5-day course of IVIG, the patient showed minimal clinical improvement. Given his advanced age, multiple comorbidities, and prior expressed wishes to avoid prolonged mechanical ventilation, the decision was made to transition to hospice care. Discussion Guillain-Barré syndrome is the leading cause of acute flaccid paralysis in the U.S., typically following respiratory or gastrointestinal infections. Diagnosis is primarily clinical but supported by findings such as CSF albuminocytologic dissociation and the presence of associated ganglioside antibodies, such as anti-GM1, anti-GD1a, anti-GT1a, and anti-GQ1b. Major complications include respiratory failure and cardiovascular instability. Treatment involves IVIG or plasma exchange. Atypical presentations, especially in elderly patients with multiple comorbidities, can delay diagnosis, particularly when symptoms mimic more common conditions like stroke. Early recognition and treatment are critical to improving outcomes, and this case underscores the need for thorough history-taking and vigilant monitoring in patients with unexplained neurological decline. This abstract is funded by: None
Baik et al. (Fri,) studied this question.