A patient of relapsing Guillain–Barré syndrome with unusual ocular presentation: a case report

Abstract Background Guillain–Barré syndrome (GBS) is an acute, immune-mediated polyneuropathy often triggered by preceding infections. It typically presents with ascending weakness, but variants such as Miller Fisher Syndrome (MFS) manifest with descending paralysis, ophthalmoplegia, and ataxia. Viral infections, including respiratory pathogens and COVID-19, are known triggers for GBS, but relapses associated with successive infections are rare. Our case demonstrates a rare presentation of relapsing GBS with ophthalmoplegia as the main presenting symptom. Case presentation We present a 46-year-old Middle Eastern man with no chronic illnesses who experienced recurrent episodes of Guillain–Barré Syndrome (GBS) triggered by viral infections, presenting in an unusual form. In 2017, he developed acute dysphagia, diplopia, and limb weakness following an upper respiratory tract infection, diagnosed as Miller Fisher variant GBS and treated successfully with IVIg. In 2022, after COVID-19 infection and ICU admission, he experienced a relapse with similar symptoms and responded well to IVIg. In 2024, he presented again with dysphagia, diplopia, and facial weakness with minimal limb involvement following an Influenza A infection. Despite initial deterioration requiring NGT insertion, gradual improvement occurred after 5 days of IVIg treatment. Nerve conduction studies confirmed demyelinating neuropathy. Conclusion This case highlights the association between viral infections and recurrent GBS, presenting with descending weakness—an uncommon feature—emphasizing the importance of early recognition and management, even when clinical presentations deviate from typical patterns.