J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

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Case Report

Volume 12, Number 3, March 2021, pages 115-118

A Case Report of Guillain-Barre Syndrome in an Eleven-Month Infant

**Table 1.** GBS in Infants Younger Than Twelve Months of Age
Author	Eden et al, 1961 [18]	Vasconcelos et al, 2012 [4]	Kishore et al, 2015 [19]	Akarcan et al, 2016 [20]	Mishra et al, 2017 [21]
GBS: Guillain-Barre syndrome; F: female; M: male; NCV: nerve conduction velocity; CSF: cerebrospinal fluid; DPT: diphtheria-pertussis-tetanus; IVIG: intravenous immunoglobulin; PE: plasma exchange; N/D: not available; CMAP: compound motor action potential; EMG: electromyography. ^aIt was not considered as a triggering factor. ^bFourth day after IVIG.
Age (month)	6	2	5	7	2
Sex	F	F	F	M	M
Days of evolution	2	5	5	10	7
Trigger (Y/N)	N	Influenza AH1N1^a	N	N	N
Previous immunization time	DPT 1 month	BCG and hepatitis B the first week of life	DPT 25 days	DPT, inactivated polio, Haemophilus influenzae and pneumococcal conjugate a previous month	N/D
Symptoms	Coryza, cough and fever, irritable, poor sucking, progressive hypoactivity	Difficulty feeding, lethargy and grunting	Cough, loose stools, breathing difficulty and listlessness	Nasal discharge and cough	Diarrhea and weakness of both lower limbs
Neurological examination	Paralysis and flaccidity of both upper limbs, absent tendon reflexes	Respiratory failure, autonomic dysfunction, symmetric distal hypotonia, absence of tendon reflexes, frog leg posture	Respiratory failure, areflexia, hypotonia and reduced power in all four limbs	Progressive weakness in the lower limbs and 2 days later in the arm, inability to sit and loss of head support, feeding difficulty and constipation, respiratory failure	Hypotonia, areflexia and absence of power in both lower limbs
CSF	Albuminocytologic dissociation	Albuminocytologic dissociation	Albuminocytologic dissociation	Normal	Albuminocytologic dissociation
NCV	-	No motor response of the bilateral median, ulnar, fibular and posterior tibial nerves, on both sides	Absent CMAP in both common peroneal nerves and increased distal latency, and absence of wave F	Decreased amplitude of action potentials	Increased proximal latency in lower limbs, decreased CMAP, conduction velocity in tibial and common peroneal nerves bilateral, and absence of wave F
Stool culture	Negative	Negative	Negative	Negative	Negative
Treatment	Vit B1 and B12	IVIG 1 g/kg/dose, 2 days	IVIG 1 g/kg/dose	IVIG 1 g/kg/dose, 2 days, PE (3 sessions)^b, IVIG 2 g/kg/dose	IVIG 1 g/kg/dose, 2 days
Improvement	2 week	Totally dependent on mechanical ventilation	Tracheostomy for prolonged ventilation. At 4 weeks, ventilation was withdrawn.	6 weeks	4 weeks

Table 1. GBS in Infants Younger Than Twelve Months of Age

Author

Eden et al, 1961 [18]

Vasconcelos et al, 2012 [4]

Kishore et al, 2015 [19]

Akarcan et al, 2016 [20]

Mishra et al, 2017 [21]

GBS: Guillain-Barre syndrome; F: female; M: male; NCV: nerve conduction velocity; CSF: cerebrospinal fluid; DPT: diphtheria-pertussis-tetanus; IVIG: intravenous immunoglobulin; PE: plasma exchange; N/D: not available; CMAP: compound motor action potential; EMG: electromyography. ^aIt was not considered as a triggering factor. ^bFourth day after IVIG.

Age (month)

Sex

Days of evolution

Trigger (Y/N)

Influenza AH1N1^a

Previous immunization time

DPT 1 month

BCG and hepatitis B the first week of life

DPT 25 days

DPT, inactivated polio, Haemophilus influenzae and pneumococcal conjugate a previous month

N/D

Symptoms

Coryza, cough and fever, irritable, poor sucking, progressive hypoactivity

Difficulty feeding, lethargy and grunting

Cough, loose stools, breathing difficulty and listlessness

Nasal discharge and cough

Diarrhea and weakness of both lower limbs

Neurological examination

Paralysis and flaccidity of both upper limbs, absent tendon reflexes

Respiratory failure, autonomic dysfunction, symmetric distal hypotonia, absence of tendon reflexes, frog leg posture

Respiratory failure, areflexia, hypotonia and reduced power in all four limbs

Progressive weakness in the lower limbs and 2 days later in the arm, inability to sit and loss of head support, feeding difficulty and constipation, respiratory failure

Hypotonia, areflexia and absence of power in both lower limbs

CSF

Albuminocytologic dissociation

Normal

Albuminocytologic dissociation

NCV

No motor response of the bilateral median, ulnar, fibular and posterior tibial nerves, on both sides

Absent CMAP in both common peroneal nerves and increased distal latency, and absence of wave F

Decreased amplitude of action potentials

Increased proximal latency in lower limbs, decreased CMAP, conduction velocity in tibial and common peroneal nerves bilateral, and absence of wave F

Stool culture

Negative

Treatment

Vit B1 and B12

IVIG 1 g/kg/dose, 2 days

IVIG 1 g/kg/dose

IVIG 1 g/kg/dose, 2 days, PE (3 sessions)^b, IVIG 2 g/kg/dose

IVIG 1 g/kg/dose, 2 days

Improvement

2 week

Totally dependent on mechanical ventilation

Tracheostomy for prolonged ventilation. At 4 weeks, ventilation was withdrawn.

6 weeks

4 weeks