Guillain-Barré syndrome associated with Dengue: case report

Abstract

The arbovirus that has gained the most relevance in recent years is dengue, due to its increasing incidence, especially in South America. Neurological manifestations of dengue are uncommon, these include Guillain-Barré Syndrome (GBS), which is characterized by an acute monophasic immunologically mediated polyradiculoneuropathy. The mechanism by which the dengue virus triggers GBS is unknown. Most cases are described as post-infectious; however, the rapid progression of polyradiculoneuropathy during the acute phase of these arboviruses suggests that direct viral mechanisms may be involved in its pathogenesis. This case report aims to highlight the importance of considering this association in clinical practice, especially in endemic areas where the likelihood of occurrence is increased.

Case Report: A 34-year-old man was admitted to the intensive care unit with a diagnosis of GBS. He presented with severe quadriparesis, generalized arreflexia, swallowing disorders, loss of head control, and respiratory muscle weakness, requiring non-invasive ventilation (NIV). Admission laboratory results were: Hemoglobin: 16 g/dL, hematocrit: 47%, leukocytes: 14,000/mm³, platelets: 320,000/mm³, procalcitonin: 0.69 ng/ml, HIV and VDRL negatives, without renal failure. Plasmapheresis was performed. He developed marked hypovolemic shock and vasoplegia on hemodynamic monitoring, requiring fluid expansion with crystalloids, vasoactive agents (norepinephrine + vasopressin), and orotracheal intubation, along with empirical antibacterial treatment (Piperacillin/Tazobactam + Vancomycin). Further diagnostic tests were performed to investigate other potential causes for his decompensation. A PCR test for dengue was carried out, with a positive result. He later developed ventilator-associated pneumonia (VAP), underwent a percutaneous tracheostomy, and received continuous kinesiotherapy, resulting in successful decannulation after 20 days of hospitalization. He was finally discharged for neurorehabilitation with a good recovery.

It is important to consider the association between GBS and dengue virus in the context of epidemiological outbreaks or in endemic regions. Confirmatory serological tests for dengue (NS1, IgM, and IgG) allow timely treatment, which can significantly improve the prognosis for these patients.