Case Report: Post-surgical Guillain-Barré syndrome as a rare differential diagnosis of flaccid paralysis of the lower extremities in an infant after cardiac surgery
IntroductionGuillain-Barré syndrome (GBS) is an important cause of flaccid paralysis in children and is mainly associated with antecedent infections. Surgery as an additional trigger for GBS is a well-documented phenomenon in adults, but is significantly less reported in pediatric patients. This cas...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1610035/full |
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| author | Maximilian Gross Rafal Berger Felix Neunhoeffer Johannes Nordmeyer Andrea Bevot |
| author_facet | Maximilian Gross Rafal Berger Felix Neunhoeffer Johannes Nordmeyer Andrea Bevot |
| author_sort | Maximilian Gross |
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| description | IntroductionGuillain-Barré syndrome (GBS) is an important cause of flaccid paralysis in children and is mainly associated with antecedent infections. Surgery as an additional trigger for GBS is a well-documented phenomenon in adults, but is significantly less reported in pediatric patients. This case report describes an infant with post-surgical GBS following cardiac surgery, highlighting the diagnostic challenges and differential diagnoses of post-surgical GBS in the pediatric intensive care setting.Case descriptionA former extremely preterm infant with congenital cytomegalovirus (CMV) infection underwent a second surgery for re-coarctation of the aorta with aortic arch hypoplasia at the chronological age of six months. While requiring extracorporeal membrane oxygenation postoperatively, the girl presented with flaccid paralysis of the lower extremities. Magnetic resonance imaging of the brain, spine, and nerve conduction studies demonstrated findings consistent with acute motor-sensory axonal neuropathy-type GBS. She was treated with intravenous immune globulin and ganciclovir due to CMV reactivation (plasma 14,000 copies/ml). Gradual neurological improvement was noted over the following months, while persistent motor deficits remained, suggesting potential disease transition into chronic inflammatory demyelinating polyneuropathy.ConclusionsThis case report emphasizes the importance of considering post-surgical GBS in critically ill children with postoperative paralysis. Recognition may be delayed due to variable initial presentations and accompanying factors such as sedation and extracorporeal life support. |
| format | Article |
| id | doaj-art-aacf75491c054e31b9544880128a8d9d |
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| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| spelling | doaj-art-aacf75491c054e31b9544880128a8d9d2025-08-20T02:32:33ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-06-011310.3389/fped.2025.16100351610035Case Report: Post-surgical Guillain-Barré syndrome as a rare differential diagnosis of flaccid paralysis of the lower extremities in an infant after cardiac surgeryMaximilian Gross0Rafal Berger1Felix Neunhoeffer2Johannes Nordmeyer3Andrea Bevot4Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen, GermanyDepartment of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Tübingen, GermanyDepartment of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen, GermanyDepartment of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen, GermanyDepartment of Neuropediatrics, General Pediatrics, Diabetology, Endocrinology and Social Pediatrics, University Children’s Hospital Tübingen, Tübingen, GermanyIntroductionGuillain-Barré syndrome (GBS) is an important cause of flaccid paralysis in children and is mainly associated with antecedent infections. Surgery as an additional trigger for GBS is a well-documented phenomenon in adults, but is significantly less reported in pediatric patients. This case report describes an infant with post-surgical GBS following cardiac surgery, highlighting the diagnostic challenges and differential diagnoses of post-surgical GBS in the pediatric intensive care setting.Case descriptionA former extremely preterm infant with congenital cytomegalovirus (CMV) infection underwent a second surgery for re-coarctation of the aorta with aortic arch hypoplasia at the chronological age of six months. While requiring extracorporeal membrane oxygenation postoperatively, the girl presented with flaccid paralysis of the lower extremities. Magnetic resonance imaging of the brain, spine, and nerve conduction studies demonstrated findings consistent with acute motor-sensory axonal neuropathy-type GBS. She was treated with intravenous immune globulin and ganciclovir due to CMV reactivation (plasma 14,000 copies/ml). Gradual neurological improvement was noted over the following months, while persistent motor deficits remained, suggesting potential disease transition into chronic inflammatory demyelinating polyneuropathy.ConclusionsThis case report emphasizes the importance of considering post-surgical GBS in critically ill children with postoperative paralysis. Recognition may be delayed due to variable initial presentations and accompanying factors such as sedation and extracorporeal life support.https://www.frontiersin.org/articles/10.3389/fped.2025.1610035/fullpediatric Guillain-Barré syndromepost-surgical flaccid paralysiscoarctationcase reportcytomegalovirus |
| spellingShingle | Maximilian Gross Rafal Berger Felix Neunhoeffer Johannes Nordmeyer Andrea Bevot Case Report: Post-surgical Guillain-Barré syndrome as a rare differential diagnosis of flaccid paralysis of the lower extremities in an infant after cardiac surgery Frontiers in Pediatrics pediatric Guillain-Barré syndrome post-surgical flaccid paralysis coarctation case report cytomegalovirus |
| title | Case Report: Post-surgical Guillain-Barré syndrome as a rare differential diagnosis of flaccid paralysis of the lower extremities in an infant after cardiac surgery |
| title_full | Case Report: Post-surgical Guillain-Barré syndrome as a rare differential diagnosis of flaccid paralysis of the lower extremities in an infant after cardiac surgery |
| title_fullStr | Case Report: Post-surgical Guillain-Barré syndrome as a rare differential diagnosis of flaccid paralysis of the lower extremities in an infant after cardiac surgery |
| title_full_unstemmed | Case Report: Post-surgical Guillain-Barré syndrome as a rare differential diagnosis of flaccid paralysis of the lower extremities in an infant after cardiac surgery |
| title_short | Case Report: Post-surgical Guillain-Barré syndrome as a rare differential diagnosis of flaccid paralysis of the lower extremities in an infant after cardiac surgery |
| title_sort | case report post surgical guillain barre syndrome as a rare differential diagnosis of flaccid paralysis of the lower extremities in an infant after cardiac surgery |
| topic | pediatric Guillain-Barré syndrome post-surgical flaccid paralysis coarctation case report cytomegalovirus |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1610035/full |
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