Guillain-Barré Syndrome following Denosumab Administration in a Patient with Chronic Kidney Disease

Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy most often triggered by infections, but drug-induced cases are increasingly recognized. Denosumab, a monoclonal antibody against receptor activator of nuclear factor kappa-B ligand (RANKL), is rarely associated with neurological adverse events. We report a case of a 60-year-old gentleman with chronic kidney disease (CKD) presented with progressive, symmetrical limb weakness and respiratory distress. Three weeks earlier, the patient had received subcutaneous denosumab (60 mg) for osteoporosis. A diagnosis of probable denosumab-induced GBS was made using World Health Organization–Uppsala Monitoring Centre causality assessment. Denosumab may influence immune regulation via RANKL inhibition, potentially predisposing to autoimmune neuropathies. This case adds to the sparse literature linking denosumab with GBS and highlights the diagnostic challenge in patients without classical infectious triggers. Clinicians should remain vigilant for neuromuscular symptoms in patients receiving denosumab, especially those with CKD. Early recognition and prompt immunotherapy can improve outcomes. Pharmacovigilance reporting is essential to clarify the neurological safety profile of denosumab.