From paralytic ileus to Guillain-Barre Syndrome: A diagnostic puzzle

Guillain-Barre Syndrome (GBS) is a rare, acute neuro-immunological disorder that affects the peripheral nerves, characterised by rapid, ascending symmetrical limb weakness and sensory deficits. Autonomic dysfunction is reported in 40-45% of GBS cases, typically manifesting in the later stages. However, it is uncommon for paralytic ileus to be the initial presenting symptom before motor and sensory deficits become apparent. We report a case of GBS in a young man who had paralytic ileus as his primary presenting complaint. The patient was managed supportively, but showed minimal improvement. A subsequent neurological assessment revealed proximal myopathy of 4 limbs with generalised areflexia. Nerve conduction study showed electrophysiological evidence of diffuse sensory motor axonal neuropathy affecting the lower limb more than the upper limb. He underwent plasma exchange therapy, in his fourth week of illness. With plasma exchange, his abdominal symptoms resolved, but neurological recovery remained partial. The delayed diagnosis likely affected his outcome, highlighting the importance of early GBS recognition for timely treatment to achieve better recovery.