Paralytic Ileus as the Initial Presentation of Guillain-Barre Syndrome: A Rare Case Report

Emerging symmetrical limb weakness, altered sensory perception, and absent or reduced deep tendon reflexes are the hallmarks of Guillain-Barre syndrome (GBS). There are numerous studies that indicate up to two-thirds of patients with GBS may also have autonomic dysfunction. One uncommon presenting characteristic of GBS before motor weakness is evident is paralytic ileus, a sign of gastrointestinal dysautonomia. Here we describe the case of a 55-year-old man who was brought to the emergency room of our hospital with paralytic ileus, a less common symptom of early-stage GBS. The patient was initially treated with prokinetic drugs and total parenteral nutrition with no clinical improvement. The patient quickly developed ascending lower limb weakness that progressed to quadriplegia, which ultimately affected respiratory muscles, leading to respiratory failure requiring mechanical ventilation and intensive care unit hospitalization. A nerve conduction study showed demyelinating sensorimotor polyneuropathy. Analysis of cerebrospinal fluid revealed albumin-cytological dissociation. The patient was treated with intravenous immunoglobulin (IVIG) and other supportive treatments. Even though the patient's enteral feeding support was uncomfortable due to a profound infection complicating lack of stomach emptying during the hospital stay, the patient passed away two months after being admitted. Lack of awareness about GBS gastrointestinal dysautonomia may cause delays in treatment initiation, and as a result, GBS may lead to life-threatening events. Reducing mortality and morbidity from GBS requires prompt diagnosis and treatment. This case reminds us that GBS may present as gastrointestinal dysautonomia.