Guillain–Barré Syndrome Following Dengue Infection: A Case Series with Review of Literature

Background: Guillain-Barré syndrome (GBS) is a rare, immune-mediated disorder of the peripheral nerve and roots often triggered by infections. Purpose: We report clinical profile, electrophysiological variants and response to treatment in five cases of GBS patients following dengue fever. Methods: Patients fulfilling the National Institute of Neurological and Communicative Disorders and Stroke criteria for GBS following dengue infections were consecutively enrolled. Their demographic, biochemical and nerve conduction study (NCS) was done. According to NCS, they were categorised into acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy, acute motor sensory axonal neuropathy (AMSAN), inexcitable motor nerve and equivocal. Disability was assessed using the 0-6 Guillain-Barré Syndrome Disability Scale or Hughes Functional Grading Scale. Results: Five patients of GBS following dengue fever were recruited (3 male and 2 female) with ages between 24 and 55 years. Diagnosis of dengue was based on serological evidence showing IgM and nonstructural protein 1 positivity. All the patients presented with an acute onset of progressive symmetrical flaccid paralysis. NCS showed a demyelinating pattern in four patients and an AMSAN pattern in one patient. All the patients were treated with intravenous immunoglobulin (IVIG) @2 g/kg/body weight given over 5 days. Modified Hughes grade at presentation was 4 in four patients, and one patient had a modified Hughes grade 5. At 1 month of follow-up, the patient with the AIDP variant showed good recovery and was able to ambulate unaided. Conclusion: GBS following dengue infection usually presents within 2 weeks of infection. In these patients, AIDP variant GBS are more common, and they show good response to IVIG treatment.