Abstract

Guillain-Barré syndrome (GBS) is an acute immune-mediated disorder of the peripheral nervous system characterized as bilaterally progressive symmetrical muscle weakness, hyporeflexia or areflexia. It is usually preceded by a respiratory or gastrointestinal infection. It's occurrence alongside viral meningitis is exceedingly uncommon and has rarely been documented in previous case reports.

A 46-year-old female patient was presented to the emergency department with chief complaints of bilateral lower limb weakness with tingling, numbness for the past 15 days. Patient had a

self-limiting episode of diarrhea and vomiting lasting one day before the onset of symptoms. On the 3rd day of hospitalization, the patient suddenly developed altered sensorium and fever. On motor examination, reduced power with hyporeflexia and hypotonia in bilateral lower limbs were present. Reduced sensations were noted in both upper and lower limb respectively. Signs of neck rigidity was present. Nerve conduction study results were consistent with the diagnosis of GBS. Xray suggested Hilar prominence. CSF examination resulted in raised lymphocyte count diagnosing viral meningitis with raised protein level. On presentation, the patient was catheterised due to retention of urine. The patient vitals were normal at presentation but on the 3rd day of hospitalization the patients developed autonomic dysfunctions presenting as orthostatic hypotension with tachycardia, hyponatremia and diarrhea followed by constipation. For GBS, IVIG course was started for 5 days and for viral meningitis Ceftriaxone, Dexamethasone and Vancomycin were started. Autonomic dysfunctions were symptomatically managed. Albuminocytologic dissociation, which is characterized by elevated CSF protein levels in the absence of elevated white blood cells, is commonly observed in GBS patients. However, the presence of viral meningitis complicated the diagnostic interpretation due to the increased cell count in the CSF. Further research is necessary to understand the underlying mechanism of development of GBS in a viral meningitis patient. This case report contributes uniquely to the literature by documenting a case of GBS with viral meningitis among the clinicians to spread awareness about the presentation of GBS as an rare but potential complication of viral meningitis.