Autonomic Dysfunction and Plasmapheresis Intolerance in Guillain-Barré Syndrome: A Case Report

Abstract

Guillain-Barré syndrome is an acute immune-mediated polyradiculoneuropathy and a major cause of acute flaccid paralysis, often triggered by antecedent infections through molecular mimicry. Autonomic dysfunction is a significant complication that contributes to morbidity, mortality, and challenges in treatment. We report a case of a 27-year-old previously healthy male who developed progressive ascending weakness following an episode of acute gastroenteritis. Clinical evaluation and electrophysiological findings were consistent with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) with secondary axonal involvement. The patient developed significant dysautonomia, manifesting as tachycardia, hypotension, diaphoresis, and respiratory discomfort during therapeutic plasma exchange. Plasmapheresis had to be discontinued after three sessions due to intolerance related to autonomic instability. The case highlights the clinical complexity of managing GBS with severe autonomic dysfunction and emphasizes the importance of close hemodynamic monitoring and individualized therapeutic strategies in patients undergoing immunomodulatory treatment.