SHM Converge Scientific Abstract ePoster Gallery-Guillain Barré: A Rare Flare in an Immunosuppressed Post-Coronavirus-19 Patient

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This case describes a 59-year-old Caucasian man who was eight months post–liver transplant and taking tacrolimus and prednisone when he developed Guillain-Barré syndrome (GBS) about one month after a COVID-19 infection. His symptoms progressed rapidly from paresthesias in all extremities to generalized weakness, dysphagia, dysarthria, and unilateral Bell’s palsy. He was diagnosed clinically with GBS and treated with a 5-day course of intravenous immunoglobulin (IVIG), after which he improved enough to avoid mechanical ventilation and was discharged to rehabilitation.<br /><br />He returned about 1.5 months later with new unilateral weakness, persistent facial droop, areflexia, and significant neuropathic pain. Imaging ruled out stroke or spinal pathology. He was diagnosed with a GBS relapse and received another 5-day IVIG course, but showed minimal improvement.<br /><br />The report highlights that GBS is a rare autoimmune neurologic disorder that usually presents with ascending weakness and decreased reflexes, often following infection. It can become life-threatening if respiratory muscles are affected. IVIG or plasma exchange are standard treatments and should not be delayed.<br /><br />The authors emphasize that immunosuppressed patients may present atypically and may have prolonged or unusual disease courses. In this case, possible contributors included tacrolimus exposure and recent SARS-CoV-2 infection, both of which have been associated in the literature with GBS. The key takeaways are to maintain suspicion for GBS in immunocompromised patients, start treatment promptly, and closely monitor for respiratory compromise and residual neurologic deficits.

Asset Subtitle

David K. Twitchell

Meta Tag

Author List David K. Twitchell, Lara Voigt

Category Clinical Vignettes

Concept Guillain-Barré Syndrome

Concept Ascending Weakness

Concept Respiratory Failure

Concept Intravenous Immunoglobulin

Concept Total Plasma Exchange

Distinguished Non-Finalist

Presenter Organization University of Texas Health Science Center - San Antonio

Presenting Author David K. Twitchell

Track Adult

Keywords

Guillain-Barré syndrome

COVID-19 infection

liver transplant

tacrolimus

prednisone

intravenous immunoglobulin

relapse

neuropathy

immunosuppressed patient

Bell’s palsy

Guillain-Barré Syndrome

Ascending Weakness

Respiratory Failure

Intravenous Immunoglobulin

Total Plasma Exchange