Atypical Presentation of Rapidly Progressive Guillain-Barré Syndrome With Dysautonomia in an Adolescent With Persistent Mycoplasma pneumoniae Infection: A Case Report.

BACKGROUND

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy and the leading cause of acute flaccid paralysis in children. Mycoplasma pneumoniae is a frequent antecedent infection in pediatric GBS and has been associated with a severe, rapidly progressive course with heterogeneous neurologic manifestations, creating diagnostic and therapeutic challenges. We report here an atypical case of rapidly progressive GBS in an adolescent with persistent M. pneumoniae infection.

CASE REPORT: A previously healthy 17-year-old female presented with rapidly progressive neurological deficits, including asymmetric proximal flaccid quadriparesis, hypophonia, absent gag reflex, and hyporeflexia, following M. pneumoniae infection treated with azithromycin. MRI and electrodiagnostic studies supported acute inflammatory demyelinating polyradiculoneuropathy. Despite intravenous immunoglobulin (IVIG), she deteriorated with bilateral facial palsy, ophthalmoplegia, dysautonomia, and respiratory failure due to persistent polymicrobial pneumonia requiring mechanical ventilation. The fulminant course showed overlapping features of multiple GBS variants. She received additional IVIG and subsequent plasmapheresis, resulting in gradual neurological improvement. She was discharged to inpatient rehabilitation following ventilator weaning with residual limb weakness and neurogenic bladder.

CONCLUSION

This case underscores the diagnostic and therapeutic challenges of atypical, rapidly progressive GBS in pediatric patients with persistent M. pneumoniae infection and overlapping clinical features of multiple GBS variants. Concomitant dysautonomia, acute respiratory failure, and lack of response to IVIG further emphasize the importance of early recognition and meticulous supportive care. Given that M. pneumoniae is a leading trigger of severe pediatric GBS, clinicians should maintain a high index of suspicion and promptly initiate and adapt established therapies to optimize outcomes.