SHM Converge Scientific Abstract ePoster Gallery-BEYOND CHOLINERGIC CRISIS: GUILLAIN-BA<br /><br />rré SYNDROME TRIGGERED BY ORGANOPHOSPHATE POISONING

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This case report describes a rare complication of organophosphate (OP) poisoning: delayed-onset Guillain-Barré syndrome (GBS), specifically the acute motor axonal neuropathy (AMAN) variant.<br /><br />A 39-year-old woman intentionally ingested phenthoate insecticide and initially developed typical cholinergic symptoms, including salivation, tearing, vomiting, diarrhea, respiratory distress, wheeze, and crepitations. She had low serum cholinesterase but otherwise normal routine labs, imaging, ECG, and echocardiography. She was treated with gastric lavage, atropine, oxime therapy, and mechanical ventilation, and improved enough to be discharged after 15 days.<br /><br />Five days later, she returned with new progressive weakness starting in the legs and spreading to the arms, along with dysarthria and dysphagia. Examination showed bulbar weakness, hypotonia, grade 2 power in all limbs, absent deep tendon reflexes, and intact sensation. Nerve conduction studies demonstrated a pure motor axonal polyradiculoneuropathy affecting all four limbs, and cerebrospinal fluid showed cytoalbuminological dissociation, confirming GBS (AMAN variant).<br /><br />She required ICU readmission and re-intubation due to respiratory distress and was treated with five cycles of plasmapheresis. Over 15 days, bulbar symptoms improved enough for extubation and oral intake, but limb weakness only partially recovered (MRC 3/5), and she remained unable to walk independently.<br /><br />The report emphasizes that OP poisoning can rarely trigger GBS, which is distinct from OP-induced intermediate syndrome or delayed neuropathy. Clinicians should suspect GBS when OP-exposed patients develop delayed acute flaccid paralysis, especially with areflexia, motor-predominant weakness, and CSF/NCS findings consistent with GBS. Early immunotherapy with IVIG or plasmapheresis is important for recovery, though residual weakness may persist.

Asset Subtitle

Ayushi Manghani

Meta Tag

Author List Aditya Kalwaghe, Ayushi Manghani, Rishikesh Kololikar

Category Clinical Vignettes

Concept Organophosphate Poisoning

Concept Guillain-Barré Syndrome

Concept Delayed Neurologic Complication

Concept AMAN Variant

Concept Albuminocytologic Dissociation

Distinguished Non-Finalist

Presenter Organization Internal Medicine Department, HCA Houston Healthcare, Clear Lake, Texas, USA

Presenting Author Ayushi Manghani

Track Adult

Keywords

organophosphate poisoning

Guillain-Barré syndrome

acute motor axonal neuropathy

phenthoate insecticide

delayed-onset weakness

areflexia

plasmapheresis

cholinergic symptoms

motor axonal neuropathy

acute flaccid paralysis

Organophosphate Poisoning

Guillain-Barré Syndrome

Delayed Neurologic Complication

AMAN Variant

Albuminocytologic Dissociation