Dados do Trabalho

Título

GUILLÁIN BARRÉ SYNDROME: AN ATYPICAL PRESENTATION

RESUMO

Presentation of the case
A 50-year-old man, hypertensive and pre-diabetic, reported polyarthralgia, low-grade fever, adynamia and prostration with gradual worsening for 9 days. On the fifth day of evolution, he presented voiding effort and burning pain on the extremities, followed by clear urinary retention, requiring relief probing, intestinal constipation, in addition to progressive ascending and symmetrical paraparesis. The neurological examination showed mild facial diparesis and dysphonia, grade 4 paraparesis and hyporeflexia in the lower limbs, without sensory level. 24 hours later, he already had grade 2 paraparesis. CSF with no cells and 76 mg/dL of protein. Arboviruses serologies were non-reactive, as was PCR COVID. Performed treatment with immunoglobulin 400 mg/kg/day for 5 days (starting on the 11th day) in an intensive care unit, without the need for mechanical ventilation, where he developed non-dialytic acute kidney injury, but completed the proposed regimen. Electroneuromyography revealed axonal active sensorimotor polyradiculoneuritis (AMSAN), predominantly in the lower limbs. For differential diagnosis with myeloradiculopathy, spinal MRIs with contrast were requested, which showed no relevant changes.
Discussion
GBS is an acute autoimmune polyradiculoneuritis that primarily affects the myelin of the proximal portion of peripheral nerves in an acute/subacute manner. Its most common etiology is post-infectious, but less important precipitating factors are surgery, immunization and pregnancy. The diagnosis is clinical, complemented by laboratory and electrophysiological tests, and two criteria are essential, such as progressive weakness of more than one limb or cranial muscles of varying degrees, and hyporeflexia and distal areflexia with varying degrees of hyporeflexia proximal. In this case, the patient demonstrated atypical manifestations of GBS, with urinary retention/constipation and fever at the beginning of the condition, leading to the imperative exclusion of other differential diagnoses, which did not delay the start of treatment. Given the rapid evolution, and late search for specialized medical care, the prognosis was unfavorable.
Final comments
GBS is a disease whose incidence has increased dramatically in the COVID era, and its complications can lead to high degrees of disability and, in some cases, death. Identification of GBS and early initiation of specific treatment are essential to reduce recovery time and minimize sequelae.