SHM Converge Scientific Abstract ePoster Gallery-The Cost of Caution; Balancing Urgent Intravenous Immunoglobulin Therapy in a Patient With Suspected Guillain-Barre and a Congenital Coronary Anomaly

The Cost of Caution; Balancing Urgent Intravenous Immunoglobulin Therapy in a Patient With Suspected Guillain-Barre and a Congenital Coronary Anomaly

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A 27-year-old man with a history of malignant right coronary artery (RCA) malformation, paroxysmal supraventricular tachycardia, and depression presented with 5 days of progressive ascending numbness, weakness, paresthesia, and mild facial weakness after a recent Group A streptococcal throat infection treated with amoxicillin-clavulanate. Neurologic exam showed hyporeflexia and symmetric weakness in all extremities, raising concern for Guillain-Barré syndrome (GBS).<br /><br />Initial labs, urinalysis, and CT imaging were unrevealing. Lumbar puncture showed normal cerebrospinal fluid protein and no other abnormalities, but the absence of albuminocytologic dissociation did not exclude GBS, especially early in the disease course. Because of the patient’s classic clinical picture and recent infection, IVIG was recommended.<br /><br />Treatment was complicated by his congenital RCA anomaly and prior SVT, which increased concern for IVIG-related cardiac complications such as arrhythmias or myocardial infarction. Due to the lack of advanced cardiac monitoring at the community hospital, the team deferred IVIG and arranged transfer to a quaternary care center for safer management.<br /><br />The case highlights that GBS remains a clinical diagnosis and may present before CSF changes appear. It also emphasizes the importance of balancing urgent neurologic treatment with patient-specific cardiac risk, and of coordinating multidisciplinary care when advanced monitoring is needed.

Asset Subtitle

Vinuri U. Goonesinghe

Meta Tag

Author List Lincy Philip, Neel Patel, Quandeel Haider, Rakan Al-Ahmad, Robert Valencia, Sri Harshini Gandhamaneni, Vinuri U. Goonesinghe

Category Clinical Vignettes

Concept Guillain-Barré Syndrome

Concept Intravenous Immunoglobulin

Concept Ascending Weakness

Concept Hyporeflexia

Concept Symmetric Weakness

Distinguished Non-Finalist

Presenter Organization Inspira Medical Center Mullica Hill, NJ

Presenting Author Vinuri U. Goonesinghe

Track Adult

Keywords

Guillain-Barré syndrome

ascending weakness

hyporeflexia

paresthesia

lumbar puncture

albuminocytologic dissociation

intravenous immunoglobulin

Group A streptococcal infection

cardiac arrhythmia

multidisciplinary care

Guillain-Barré Syndrome

Intravenous Immunoglobulin

Ascending Weakness

Hyporeflexia

Symmetric Weakness