Guillain-Barré syndrome: an unusual complication after snake bite

The mortality rate of the Formosan krait bite has been reported to be 23%; death is from respiratory paralysis caused by neuromuscular junctions being blocked by bungarotoxin. This article presents the first case report of Guillain-Barré syndrome after snake envenomization. The patient presented with symmetric paresis and sensory signs in the upper and lower limbs, autonomic dysfunction, facial nerve involvement, and mild elevated cerebrospinal fluid protein at about 4 weeks after the bite. Electrodiagnostic studies revealed profound sensory and motor polyneuropathy. Repeated electrophysiologic findings confirmed nerve regeneration. The patient reached satisfactory functional outcome after a short-term intensive rehabilitation program despite severe axonal degeneration. This article also discusses the possible mechanism of immunopathogenesis of Guillain-Barré syndrome after krait bite.