A Recurrent and Atypical Form of Guillain-Barré Syndrome: A Case Report

Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy characterized by rapidly progressive sensorimotor impairment that is classically ascending and monophasic. Recurrent and descending forms are rare and may complicate diagnosis. We report an atypical recurrent case of GBS in a child presenting with descending paralysis. We describe a nine-year-old girl with a history of typical GBS who was admitted to the pediatric ICU for acute descending flaccid paralysis. The clinical course rapidly progressed to tetraplegia with bulbar and respiratory involvement. Electroneuromyography showed acute demyelinating motor polyneuropathy, CSF analysis revealed albuminocytologic dissociation, spinal MRI demonstrated cauda equina nerve root enhancement, and anti-ganglioside antibodies were positive. The patient required mechanical ventilation and multiple courses of IVIG, with subsequent significant neurological recovery and complete remission at three months. Recurrent GBS is rare. Descending paralysis is atypical in this disease and may delay diagnosis. In such cases, repeated clinical evaluation and supportive paraclinical investigations are essential. The benefit of repeated courses of IVIG in poorly responsive cases remains uncertain and is supported by limited evidence. This case highlights the importance of considering GBS in acute flaccid paralysis, even in atypical and recurrent presentations, and underscores the diagnostic value of paraclinical investigations in such contexts.