CASE PRESENTATION ON GUILLAIN BARRE'S SYNDROME

A compelling case presentation of Guillain-Barre's Syndrome in Female Pediatric patient

1. Unraveling the Mysteries of Guillain-Barré Syndrome in Children : A Compelling Case Presentation Presented by : Syeda Tazeen, Pharm-D Intern

2. I n t r o d u c t i o n Guillain-Barré Syndrome (GBS) is a rare but serious autoimmune neurological disorder characterized by muscle weakness and paralysis . While it can occur at any a g e , b u t i t i s p a r ti c u l a r l y h i g h l y co n c e r n i n g wh e n i t oc c u r s in children. This c a s e p r e s e n ta ti o n w i ll e xp l o r e a s p e c i fi c c a s e o f G B S i n a young patient, highlighting the importance of early recognition and treatment of this condition.

3. B a c k g r o u nd GBS is an autoimmune condition where the body's immune system attacks the peripheral nerves which thereby causes demylination of nerves & conduction of nerve impulses is reduced . The exact etiology remains unknown, but it is often p r e c e d e d b y a b a c t e r i a l i n f e c t i o n that disturbs GI tract or viral infection that effects respiratory system. SIGNS & SYMPTOMS *NOTE : Symptoms are in Symmetrical Ascending order

4. Patient History A 9-year-old female patient weighing 25 kgs was admitted to the pediatric department with the chief complaints of weakness in bilateral lower limbs, tingling sensation, di£ficulty in walking . Parents noticed frequent falls while walking over the past three days. PRESENT ILLNESS HISTORY : Two week s prior to admission, the patient experienced illness characterized by Upper Respiratory symptoms including dry cough & low grade fever for which she was treated at a clinic and recovered . This is a common precursor to GBS, as immune system may over - react and attack body's own nerves in response to an infection. Within 24 hrs she developed bilateral lower limb weaknes; over next few days her c o n d i t i o n w o r s e n e d ; she felt parasthesis (abnormal sensations) in lower limbs, w e a k n e ss e xt e n d e d slowly and gradually t o u pp e r l i m b s therefore s h e e x p e r i e n c e d difficulty i n walking and p e r f o r m i n g fi n e m o t o r t a s k s

5. Previous History PAST MEDICAL HISTORY : No known comorbidities P A S T M E D I C A T I ON H I S T O R Y : T oo k m e d i c a t i o n s f o r f e v e r & c o u g h PAST SURGICAL HISTORY F A M I L Y H I S T O R Y VITAL DATA P R O V I S I O N A L D I A G NO S I S : Nil : No similar complaints in family : Stable : Peripheral neuropathy? GBS?

6. Diagnostic Evaluation Electrophysiological studies indicated demyelination and nerve damage, as seen in nerve conduction studies (NCS ) & needle electromyography (EMG). Cerebrospinal F luid (CSF) analysis showed elevated C-protein levels(85 mg/dl) without pleocytosis (cell count and glucose levels). Laboratory investigations ; including complete blood count, renal/liver function t e s t s , s e r u m e l e c t r o l y t e s , a n d i n f l a mm a t o r y m a r k e r s , w e r e w i t h i n no r m a l l i m i t s . Serological tests for preceding infections (e.g., Campylobacter jejuni, Epstein- Barr virus, cytomegalovirus) were negative. DIAGNOSIS : A diagnosis of Guillain-Barré syndrome (GBS) was made based on clinical presentation, electrophysiological studies, and CSF analysis .

7. The primary goal of treating pediatric GBS is to reduce symptoms, prevent complications, and promote recovery . Patient was initiated on the following management strategies: Treatment and Management However , there were some challenges that were faced during the treatment process . The patient experienced some mild side effects from the IVIG therapy, including headache & fatigue . Additionally , the treatment was quite expensive & the family had to work with their insurance company to ensure that it would be covered.

8. Over the following weeks, the patient's muscle strength improved gradually, with motor function returning in a proximal-to-distal manner. After three months, she made significant progress, almost recovering with only slight weakness in distal lower limb muscles. Follow-up neurology consultations were planned to ensure long-term monitoring of her condition. O u t c o m e

9. Guillain-Barré syndrome is a rare but significant neurological condition in pediatric patients. Timely recognition , early d i a g n o s i s & a pp r o p r i a t e m a n a g e m e n t , i n c l u d i n g s u pp o r t i v e c a r e , a n d r e h a b i l i t a t i o n a r e crucial for optimizing outcomes . Th is case highlights the importance of a multi - disciplinary approach and regular follow- up to facilitate the recovery & well-being of pediatric patients with GBS . In order to improve outcomes for pediatric patients with GBS, it is essential to raise awareness about this condition & promote early recognition and treatment . Healthcare professionals should consider GBS as a possible diagnosis in patients presenting with unexplained weakness or paralysis, and take prompt action to ensure the best possible outcome for the patient . Conclusion

10. T h a n k s Do you have any questions? LinkedIn : Tazeen Syed