SUN-688 Unexpected Consequences: Guillain-Barre Syndrome Following GLP-1 Agonist Therapy

Abstract Disclosure: S. Obialo: None. R. Jaber: None. N. Sukthanker: None. Introduction: Glucagon-like peptide-1 receptor (GLP-1) agonists are commonly prescribed for type 2 diabetes mellitus (T2DM) and obesity. Typical side effects include gastrointestinal symptoms such as nausea, vomiting, and diarrhea, with less common reports of pancreatitis. To date, no neurological adverse effects have been documented. We present what appears to be the first reported case of Guillain-Barré syndrome (GBS) potentially associated with GLP-1 agonist therapy. Clinical Case: A 43-year-old male presented to the emergency department with numbness and tingling in his first three digits of bilateral hands and in bilateral legs for several days. Also reported lower extremity weakness that resulted in multiple falls and crawling due to difficulty ambulating. He denied other associated symptoms including recent viral/bacterial illness, fevers, facial weakness, dysarthria, dysphagia, bodily trauma, incontinence, and recent vaccinations. Medical history was notable for previous class one obesity for which he was taking tirzepatide (Zepbound) for five months and had lost approximately 60 pounds. Prior to his presentation to the hospital, the final injection of tirzepatide was 9 days prior. Soon after the last injection, his symptoms began. Physical exam was notable for 3/5 toe and knee extension in bilateral lower extremities with decreased sensations from knee down bilaterally. Also, absent patellar reflexes bilaterally and decreased sensations in first three digits of bilateral hands were also noted. MRI brain without contrast showed no evidence of any intracranial process. Lumbar puncture was remarkable for elevated protein at 72 mg/dL (15 – 40 mg/dL) and nucleated cells less than 3 mcL (0 – 5 mcL), indicating cytoalbuminologic dissociation. Oligoclonal bands were absent; HIV and TSH were normal. Other imaging obtained was MRI cervical, thoracic and lumbar spine. Remaining imagining was unremarkable except for trace syrinx at C1-C2, however this finding was less likely contributory due to the distribution and location of his acute symptoms. He received five days of IVIG and had reported improvement in his symptoms. He was followed by physical therapy while hospitalized and discharged to an inpatient rehabilitation facility. Discussion: To our knowledge, this is the first reported case of GBS following use of a GLP-1 agonist. While GLP-1 agonist medications are generally well tolerated, this case highlights the importance of recognizing potential neurological complications. Clinicians should remain vigilant and consider GBS in patients presenting with progressive weakness or paresthesia during or after GLP-1 agonist therapy. Presentation: Sunday, July 13, 2025