GUILLAIN-BARRÉ SYNDROME DUE TO ENTEROPATHOGENIC ESCHERICHIA COLI WITH ATYPICAL CLINICAL PRESENTATION: A CASE REPORT.

Abstract

Guillain-Barré Syndrome (GBS) is an acute polyneuropathy characterized by progressive, symmetric, and ascending weakness, accompanied by areflexia or hyporeflexia, frequently preceded by infections. Due to its potentially fatal nature, early recognition and immediate intervention are crucial to avoid disastrous outcomes. This case describes a 57-year-old female patient admitted with a history of watery diarrhea 10 days earlier, already improving, who developed upper limb paresthesia, followed by plegia and, subsequently, tetraplegia and global areflexia. The patient maintained preserved consciousness and ocular muscle strength. Neuroaxis MRI revealed no abnormalities. With an Erasmus score (EGRIS) of 6 points, she was referred to the ICU. Cerebrospinal fluid analysis did not reveal protein–cytological dissociation. In this context, two diagnostic hypotheses were considered: botulism and atypical Guillain-Barré syndrome. The rapid progression of the neurological deficit, characterized by upper limb plegia evolving into tetraplegia, associated with dysphonia, dysarthria, dysphagia, sialorrhea, and acute respiratory failure in less than 48 hours after admission, led to the collection of samples for Clostridium botulinum identification and the empirical initiation of treatment with botulinum antitoxin AB and immunoglobulin. Subsequently, the gastroenteritis panel (24 pathogens) identified enteropathogenic Escherichia coli (EPEC), and electromyography revealed severe acute demyelinating and axonal polyradiculoneuropathy, confirming the diagnosis of atypical Guillain-Barré syndrome with onset in the upper limbs. To date, only two cases of gastroenterocolitis caused by EPEC associated with GBS have been reported; this constitutes the third, with an atypical onset.