Abstract
Introduction:
Guillain-Barré syndrome (GBS) is a rare autoimmune demyelinating disease. Symptoms vary widely and commonly include ascending bilateral weakness, pain and hyporeflexia. Approximately 30% will develop respiratory failure contributing to the high morbidity and mortality. Advancements in diagnostic and treatment have greatly decreased mortality to now less than 10%. However, GBS is still often misdiagnosed, thus delaying care.
Case Description:
A 42-year-old female presented with 1 week of back pain that now is affecting her hands and feet. Her neurological exam was within normal limits. Imaging included brain CT and MRI, chest and abdomen CT, were all unremarkable along with labs. She was discharged home with pain medication for unspecified back pain. The next day, the patient presented back to the hospital with progressive weakness and pain now occurring throughout her body. After additional workup was negative, the physicians were now considering drug addiction as a diagnosis. She was discharged home and told to follow up with her primary physician, who urgently referred her to a neurologist. The following morning, the patient saw a neurologist who recommended a lumbar puncture and nerve conduction study but were not performed due to insurance complications. She was now unable to walk and told to immediately return back to the hospital. Upon arrival, her neurological exam deteriorated further, and she was in respiratory distress. A lumbar puncture showed albuminocytologic dissociation. A nerve conduction study showed multifocal demyelinating peripheral neuropathy confirming GBS. Intravenous immunoglobin was initiated but despite several doses, her symptoms continued to worsen. She was intubated and transferred to a tertiary hospital for plasmapheresis. On Day 14 she had a tracheostomy and a percutaneous endoscopic gastrostomy tube placed and was discharged to a Long-Term Acute Care Hospital on Day 25.
Discussion:
GBS is often misdiagnosed especially when patients present with atypical symptoms, like in this case, back pain. After the more common etiologies for back pain are ruled out, and with a high index of suspicion, initiating early neurology consultation and early therapy will help slow progression. Severe progressive pain, including back pain, is a common presenting symptom and is caused from the demyelination of peripheral nerves. Multiple medical textbooks and resources emphasize the more typical symptoms such as progressive ascending neuropathy, yet few highlight the pain severity. Current studies are underway to help address this matter including increasing physicians’ awareness and comfort with diagnosing and treating GBS.
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Recommended Citation
Ho TT, Sukpraprut-Braaten S, Martin D, Clevenger M, Kinchen D, Zimmerman S, Wagner S. Severe Progressive Back Pain Causing the Misdiagnoses of Guillain-Barré Syndrome (Twice). Advances in Clinical Medical Research and Healthcare Delivery. 2022; 2(1). doi: 10.53785/2769-2779.1075.