Atypical Presentation of Postoperative Guillain-Barré Syndrome in a Pediatric Patient: A Case Report and Review of the Literature

Abstract

Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuropathy and a leading cause of acute flaccid paralysis in children. While commonly triggered by infections, GBS may rarely occur following surgical procedures. The pathogenesis of post-surgical GBS remains unclear, with immune-mediated mechanisms and perioperative factors being implicated. We report the case of a 9-year and 10-month-old girl who developed GBS one week after surgical correction of a duodenal diaphragm. She presented with rapidly progressive tetraparesis, dysphagia, and respiratory distress in an afebrile context. Neurological examination revealed flaccid tetraparesis, abolished deep tendon reflexes, and no sensory or sphincter involvement. Electroneuromyography confirmed severe sensorimotor axonal polyneuropathy. Laboratory workup and imaging were unremarkable. The patient was treated with intravenous immunoglobulin and supportive therapy, resulting in favorable neurological recovery over time, with a stable condition at a three-year follow-up. Postoperative GBS is a rare but serious complication, often underrecognized, especially in pediatric patients. This case underscores the importance of considering GBS in the differential diagnosis of acute neurological deficits following surgery. Prompt diagnosis and treatment are essential to improve outcomes. Clinicians should maintain a high index of suspicion for postoperative GBS in the setting of acute neuromuscular weakness after surgery, as early immunotherapy can lead to favorable recovery.