Guillain-Barré syndrome following Escherichia coli meningitis after cupping therapy: a case report.

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy, whereas Escherichia coli meningitis following cupping and acupuncture is a rare but severe infection. GBS as a neurological complication after E. coli meningitis is exceedingly uncommon. We report the case of a 53-year-old woman with systemic lupus erythematosus and chronic renal failure who developed headache, vomiting, and altered consciousness four days after undergoing cupping and acupuncture for low back pain. Cerebrospinal fluid (CSF) analysis and next-generation sequencing confirmed E. coli meningitis. Although meningeal signs improved with targeted antibiotic therapy, she subsequently developed progressive flaccid quadriparesis, ophthalmoparesis, and areflexia. Further evaluation revealed CSF albuminocytologic dissociation, positive serum anti-GM1 and anti-GT1a IgG antibodies, and electromyographic findings consistent with acute demyelinating polyneuropathy, leading to a diagnosis of GBS. The patient's neurological symptoms improved significantly following intravenous immunoglobulin therapy. This case illustrates that E. coli meningitis, potentially introduced via cupping or acupuncture, can trigger GBS as a severe neurological sequela. It also underscores the importance of considering GBS in the differential diagnosis when patients with bacterial meningitis develop progressive, unexplained flaccid paralysis during or after treatment. Early recognition, timely immunomodulation, and sustained rehabilitation are crucial for reducing disability.