Second Encounter with Intravenous Immunoglobulin in a Patient with Guillain–Barré Syndrome

Case RepoRtpoor outcome.One day after admission, she developed respiratory muscle paralysis, resulting in respiratory failure that required intubation and mechanical ventilation.Cerebrospinal fluid (CSF) analysis was done with the diagnosis of Guillain-Barr syndrome, which demonstrated albumin-cytological dissociation (normal cell count, elevated albumin at 353 mg/dL).Nerve conduction studies indicated pure motor axonal peripheral neuropathy affecting all four limbs.A CT spinogram excluded compressive radiculopathy.With the diagnosis of acute motor axonal neuropathy (AMAN) variant of GBS, she was started on IVIg (2 gm/kg over 5 days), but showed no improvement and continued to require mechanical ventilation.A tracheostomy was performed.A week later, she developed ventilator-associated pneumonia, which was treated with targeted antibiotics.She continued to be on mechanical ventilatory