J Korean Child Neurol Soc.  2017 Sep;25(3):191-194. 10.26815/jkcns.2017.25.3.191.

A Child with Guillain-Barré Syndrome Presenting Paralytic Ileus

• Lee SH
• Lee KH

• KMID: 2392559
• DOI: http://doi.org/10.26815/jkcns.2017.25.3.191

Abstract

Guillain-Barré syndrome (GBS) is characterized by ascending symmetric paralysis, paresthesia, and autonomic dysfunction. Autonomic dysfunctions develop in two-thirds of the patients, and urinary retention and paralytic ileus usually develop in severe and advanced cases. There has been no pediatric case with paralytic ileus as a presenting symptom of GBS. Reported herein is a case of GBS presenting vomiting as an initial symptom. A 28-month-old girl was brought to the emergency room due to a 2-day history of vomiting. She vomited multiple times 1 day before the visit, and had only single voiding on admission day. Her abdomen was distended, with decreased bowel sound. Intravenous fluid was given under the diagnosis with acute gastroenteritis with dehydration. The abdominal computed tomography revealed severe paralytic ileus and urinary bladder distention. After having two seizures, she developed respiratory failure necessitating ventilator care. On day 8 after admission, motor weakness with areflexia was noticed. The cerebrospinal fluid analysis showed elevated proteins (80 mg/dL) with no white blood cells (0/mm³). The nerve conduction study showed axonal-type peripheral polyneuropathy. GBS was diagnosed. During the follow-up, the patient was found to have motor weakness in the lower extremities. Paralytic ileus with protracted vomiting can be an initial presentation of GBS in children. Autonomic dysfunction with GBS can be considered in a differential diagnosis in vomiting patients with unclear etiologies.

Keyword

Guillain-Barré syndrome; Vomiting; Ileus

MeSH Terms

Abdomen
Cerebrospinal Fluid
Child*
Child, Preschool
Dehydration
Diagnosis
Diagnosis, Differential
Emergency Service, Hospital
Female
Follow-Up Studies
Gastroenteritis
Guillain-Barre Syndrome*
Humans
Ileus
Intestinal Pseudo-Obstruction*
Leukocytes
Lower Extremity
Neural Conduction
Paralysis
Paresthesia
Polyneuropathies
Respiratory Insufficiency
Seizures
Urinary Bladder
Urinary Retention
Ventilators, Mechanical
Vomiting