An interesting case of post dengue Guillain Barre syndrome

Abstract

Neurological manifestations of dengue fever are seen in around 0.5-6% patients. Post dengue Gullain Barre Syndrome (GBS) is uncommon and only few cases of GBS have been causally linked to serologically confirmed dengue illness. We report a case of 51-year-old male with acute onset flaccid paralysis of all 4 limbs within 1 week of dengue fever, which worsened rapidly despite early initiation of IVIG. Patient became quadriplegic with bilateral LMN facial paralysis, needing intubation and ventilation. When patient did not improve even after 3 weeks of IVIG therapy, plasmapheresis was started and 5 exchanges were given over 10 days following which patient showed significant recovery and became ambulatory and independent at 6 months. In our case 2 dose of IVIG was not considered as his serum IgG levels were raised.Role of plasmapheresis in patients of GBS, responding poorly to IVIG needs further evaluation.GBS is an uncommon neurological manifestation of dengue fever. Role of plasmapheresis in patients who respond poorly to IVIG needs to be considered.