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• W4387248878 abstract "SESSION TITLE: Critical Care Case Report Posters 61 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Guillain-Barre syndrome (GBS) is an inflammatory demyelinating polyradiculoneuropathy disorder known to be preceded by illness triggered by pathogens such as Campylobacter, CMV, EBV, and mycoplasma. It is characterized by progressive ascending weakness, hypo/areflexia, and is occasionally associated with autonomic dysfunction. We present a peculiar clinical presentation of GBS associated with cytomegalovirus infection (CMV), with a lack of characteristic cerebrospinal fluid (CSF) findings of albumino-cytologic dissociation in a middle-aged immunocompetent patient who presented with acute ascending flaccid paralysis and autonomic dysfunction with delayed onset facial palsy leading to prolonged ventilator dependency.(1) CASE PRESENTATION: A healthy 49-year-old patient presented with signs of progressive bilateral lower extremity numbness and weakness along with paresthesias in the upper extremities after a recent diarrheal illness. This progressed to acute respiratory failure requiring mechanical ventilation. Spinal tap was unrevealing and ruled out an infectious etiology. MRI brain showed few foci of hyperintense lesions within the periventricular white matter. MRI lumbar spine revealed enhancement of cauda equina nerve roots, nonspecific heterogeneous signal in L4-L5. He tested positive for CMV PCR Ag, IGG CMV ab, and IGM CMV ab. The patient developed worsening quadriplegia, despite being on IVIG. Plasma exchange, steroids, and valganciclovir were started. The patient's neurological status improved albeit slowly and still requires mechanical ventilation via tracheostomy. He also developed episodes of sinus tachycardia/bradycardia with hypertension and left-sided weakness in the distribution of facial nerve likely delayed complications from GBS. DISCUSSION: This case is interesting in describing multitudes of rare neurologic findings of GBS that led to prolonged complicated hospital courses with residual disability. Evidence from literature suggests the abnormal CSF finding may be present in only 50-64%, especially in the first week of symptom onset. Likewise, an antecedent cytomegalovirus infection is known to occur in 6% of cases and is unusual in an immunocompetent patient. Our patient also had rapid progression of his weakness leading to prolonged respiratory failure suspicious for atypical AMAN/AMSAN variant of GBS, although the anti-ganglioside antibodies were negative. This case was also notable for delayed unilateral cranial nerve VII deficits which are reported to have an incidence of 6% as per prior literature. This case is indicative of a peculiar rapidly progressing variant of GBS with many typical and atypical clinical findings which could be helpful in diagnosing, prognosticating, and management of further similar GBS cases. Our patient exhibited signs of autonomic dysfunction, which may manifest as cardiac arrhythmias and blood pressure instability. This can lead to mortality in 3–10% of patients, even with the best medical care available. (2) CONCLUSIONS: Guillain-Barré syndrome is still a life-threatening disorder with the highest risk of mortality in the acute progressive stage due to ventilatory insufficiency, pulmonary complications, or from autonomic dysfunction including arrhythmia. (3) Physicians need to have a high degree of clinical suspicion for GBS as the clinical course is highly variable and requires early recognition and personalized treatment. Physicians also need to be aware of the different variants of GBS and the available therapies like IVIG and plasmapheresis and utilize them in a timely manner. REFERENCE #1: 1. Berg B van den, Storm EF, Garssen MJP, Blomkwist-Markens PH, Jacobs BC. Clinical outcome of Guillain-Barré syndrome after prolonged mechanical ventilation. J Neurol Neurosurg Psychiatry. 2018;89(9):949-954. doi:10.1136/jnnp-2018-317968 REFERENCE #2: 2. Jacobs BC, van Doorn PA, Groeneveld JH, Tio-Gillen AP, van der Meche FG. Cytomegalovirus infections and anti-GM2 antibodies in Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 1997;62(6):641-643. doi:10.1136/jnnp.62.6.641 REFERENCE #3: 3. Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. The Lancet. 2016;388(10045):717-727. doi:10.1016/S0140-6736(16)00339-1 DISCLOSURES: No relevant relationships by Arij Azhar No relevant relationships by Rupa Garikipati No relevant relationships by Louis Gerolemou No relevant relationships by Wael Kalaji No relevant relationships by Olga Knap No relevant relationships by Vikash Kumar No relevant relationships by Kunal Nangrani No disclosure on file for Jose Orsini No relevant relationships by Gaurav Parhar No relevant relationships by Anuj Shivalingaiah No relevant relationships by RISHAV Sinha No relevant relationships by Seungmo Suh No relevant relationships by Kiran Zaman" @default.
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• W4387248878 date "2023-10-01" @default.
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• W4387248878 title "UNPREDICTABLE COURSE OF GUILLAIN-BARRÉ SYNDROME: AN ICU PERSPECTIVE" @default.
• W4387248878 doi "https://doi.org/10.1016/j.chest.2023.07.1349" @default.
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