Guillain-Barré Syndrome Secondary to Snake Bite: A Report of a Rare and Fatal Case

BACKGROUND Guillain-Barre syndrome (GBS) is a rare disorder arising due to immune-mediated damage to the peripheral nervous system. It most commonly occurs as a sequela of respiratory or gastrointestinal infections; however, in rare instances, cases may arise after snakebite envenomation. Several variants of GBS have been identified, with acute inflammatory demyelinating polyneuropathy (AIDP) being the most common, including our case. Other forms, such as acute motor axonal neuropathy (AMAN), are also more prevalent in tropical regions of Southeast Asia, as well as Central and South America. CASE REPORT A 52-year-old farmer from rural northern India presented with ascending palsy progressing for the past 3 days, along with bulbar symptoms and respiratory involvement for 1 day. He had been recently hospitalized a few weeks ago for snake-bite-associated neuroparalysis that had gradually resolved without any complications before discharge. Laboratory investigations and chest X-ray on presentation were suggestive of aspiration pneumonia, leading to initiation of empiric antibiotics. A diagnosis of AIDP variant of GBS was reached on the second day of admission, based on CSF studies showing albuminocytologic dissociation, and nerve conduction studies suggestive of axonal neuropathy in lower-limb nerves, and demyelination that was more pronounced in the lower limbs than in the upper limbs. He subsequently received a dose of IVIG, and was intubated for mixed hypoxic-hypercapnic respiratory failure. However, the worsening hemodynamic instability due to sepsis and GBS-related autonomic dysfunction, despite the antibiotic escalation and vasopressor support, eventually culminated in death. CONCLUSIONS This case underscores the importance of recognizing Guillain-Barre syndrome (GBS) as a neuroimmune sequela of snakebite envenomation, and the need for close neurological monitoring, patient and caregiver education, and physician awareness for early symptom recognition, and prompt initiation of empiric treatment to avoid delayed diagnoses and subsequent fatal complications.