Unusual Presentation of Legionella as an Acute Flaccid Quadriparesis in a Case of Guillain-Barre Syndrome

Guillain-Barré Syndrome (GBS) is a rare polyradiculoneuropathy of the peripheral nerves and, occasionally, the cranial nerves, causing dysfunction, segmental demyelination, and/or axonal degeneration. GBS is considered an autoimmune disease because the body’s own immune system attacks its own tissues. There is a strong association between GBS and preceding acute infectious illness. Aetiology is unknown in most cases. GBS has been less commonly reported in association with Legionella. Furthermore, unusual GBS-related clinical signs might lead to confusion and incorrect diagnoses, like transverse myelitis, spinal cord compression, stroke, infections, myasthenia, and periodic paralysis. To establish the diagnosis of GBS, patient history, electrophysiological assessments, neurological evaluations, and Cerebrospinal Fluid (CSF) analyses are equally important. Hereby, the authors present a case report of 75-year-old male patient who presented with a history of fever spikes and diarrhoea 10 days prior, followed by the acute onset of ascending paralysis and hypertension. A systemic examination revealed right eye ptosis, loss of power in the bilateral lower limbs, areflexia, and diminished sensory function. Further evaluation through nerve conduction studies showed findings suggestive of demyelinating axonal sensory-motor polyneuropathy involving all four limbs. Based on the clinical suspicion of an acute infectious illness history followed by ascending paralysis, the patient was investigated for the cause of GBS, which was found to be Legionella. The patient was treated with plasmapheresis and physiotherapy and is now on regular follow-up.