Presumed oxaliplatin-related Guillain–Barré syndrome

RATIONALE: Oxaliplatin, a platinum-based chemotherapeutic widely used in colorectal, hepatobiliary, and pancreatic malignancies, commonly causes a symmetric, cold-induced sensory neuropathy. Rarely, it has been linked to immune-mediated Guillain-Barré Syndrome (GBS), which can be misattributed to drug-induced sensory neuropathy and delay diagnosis. Distinguishing the two is critical because GBS can progress to respiratory failure and death. PATIENT CONCERNS: A 77-year-old woman with concurrent metastatic cholangiocarcinoma and colorectal carcinoma developed acute, symmetric, ascending motor weakness with clinically preserved sensation approximately 2 weeks after her last cycle of gemcitabine, oxaliplatin, leucovorin, and 5-fluorouracil (GOLF), rapidly progressing to an inability to ambulate. DIAGNOSIS: Neurological examination and cerebrospinal fluid analysis (albuminocytologic dissociation) were consistent with GBS, and nerve conduction studies demonstrated absent motor and sensory responses, indicating a severe axonal variant (AMSAN); sensory involvement was electrodiagnostic rather than clinical. An extensive infectious, autoimmune, and paraneoplastic workup was negative, supporting a diagnosis of presumed oxaliplatin-related GBS; a Naranjo score of 4 indicated a "possible" drug association. INTERVENTIONS: She received 5 sessions of therapeutic plasma exchange followed by 4 sessions of intravenous immunoglobulin. OUTCOMES: No meaningful neurological recovery occurred; she developed progressive respiratory failure requiring mechanical ventilation and died. LESSONS: Clinicians should maintain a high index of suspicion for GBS in patients on platinum-based chemotherapy who develop abrupt, symmetric motor weakness after common causes have been ruled out. Because causality is difficult to establish, the association remains presumed; early recognition, prompt immunotherapy, and pharmacovigilance are essential to reduce mortality.