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Fulminant Guillain-Barrè syndrome after Campylobacter jejuni enteritis and anti-ganglioside antibody.

Guillain-Barre Syndrome (GBS) is clinically defined characterized by the acute onset of limb weakness and areflexia. In approximately 90% of patients, evolution of the disease follows a pattern of characteristic for typical GBS(1, 2). Weakness follows the sensory manifestations, beginning typically in the leg and ascending to the arm. Rarely, weakness may affect predominantly the pharyngeal, neck, and upper limb muscles (cervical-pharyngeal-brachial variant, PCB) (1 , 3). In GBS, approximately 15% of patients have oculomotor paresis at some time in the disease course; the degree of eye movement weakness evolves to complete ophthalmoparesis (1 , 2). Facial muscles are also weak in approximately 60%of cases. About one-third of patients eventually require ventilator assistance, during this course ( 1 , 2, 4). Autonomic involvement (such as labile blood pressure, hypertension, postural hypotension), and life-threatening rhythm disturbances (bradycardia, sinus arrest) (5, 6), bladder dysfunction, and constipation occur in GBS(1, 2). GBSwith severe sensory and autonomic disturbances are, in generaly, called fulminant GBS. Most patients of GBSbecome maximally weak within 2 weeks of onset, and essentially all reach a nadir by 4 weeks (1, 2, 7). Despite significant advances in both supportive and immunomodulating therapy, 8% of patients with GBS die (8). Prolonged disability occurs in those with fulminant GBS.Permanent disability, usually affecting the lower limbs occurs in about 10%(9). Sometimes, residual disability can leave the patient wheelchair dependent, or walking only with ambulatory aids. Impaired quality of life may persist for manyyears or to the end of their life. Poor prognostic factors include age, the need for ventilatory support, rapidly progressive weakness prior to presentation, a prolonged course of active disease, preceding, diarrhea illness (presumably caused by Campylobacter jejuni in most cases). However, these prognostic factors should never be used as a basis for deferring treatment in an individual patient.