Guillain-Barré Syndrome Presenting with Sinus Node Dysfunction and Refractory Shock.

Area of Science:

• Neurology
• Autonomic Nervous System Disorders

Background:

• Guillain-Barré syndrome (GBS) is an inflammatory polyneuropathy typically presenting with ascending paralysis.
• GBS is often preceded by infections, affecting the peripheral nervous system.

Observation:

• A 76-year-old male presented with diaphoresis and altered mental status, rapidly progressing to severe bradycardia and refractory hypotension.
• Initial management with dopamine and temporary pacing did not resolve the hypotension, suggesting autonomic dysfunction.

Findings:

• Lumbar puncture revealed albuminocytologic dissociation, confirming a diagnosis of Guillain-Barré syndrome.
• The patient experienced complications including acute kidney injury and metabolic acidosis, ultimately succumbing to multi-organ failure.

Implications:

• This case underscores that autonomic dysfunction, though rare, is a recognized manifestation of GBS.
• Clinicians should consider GBS in the differential diagnosis for patients presenting with unexplained bradycardia and hypotension.