Guillain-Barré syndrome
USMLE Step 2 CKDifficulty: easyLast updated:
A 34-year-old man presents with 5 days of progressive, symmetric weakness that began in his feet and has ascended to his thighs and hands, with tingling in his fingers and toes. Two weeks earlier he had a diarrheal illness. He cannot walk without assistance. Deep tendon reflexes are absent throughout. Cerebrospinal fluid shows a protein of 118 mg/dL and 2 leukocytes/mm3. Forced vital capacity is 2.6 L and is being monitored. He is admitted to the intensive care unit.
Which of the following is the most appropriate disease-specific therapy?
Answer and explanation
Correct answer: D. Intravenous immune globulin
Rapidly progressive ascending symmetric weakness with areflexia after a diarrheal illness, such as Campylobacter jejuni infection, together with CSF showing raised protein and a normal cell count (albuminocytologic dissociation), indicates Guillain-Barré syndrome. The source notes that this CSF finding may not appear for up to 1 week. Treatment is intensive supportive care with IV immune globulin (IVIG) or plasma exchange. Forced vital capacity is measured every 6 to 8 hours so that ventilation can be started if needed. The source states that glucocorticoids are not indicated, because they do not hasten recovery and may delay it or worsen outcome. Pyridostigmine treats myasthenia gravis, and acyclovir treats herpes viral infections.
Each option explained
- A. PyridostigmineIncorrect. Pyridostigmine treats myasthenia gravis, which causes fatigable weakness with preserved reflexes.
- B. Intravenous acyclovirIncorrect. Acyclovir treats herpesvirus infections such as HSV encephalitis; the CSF shows no pleocytosis.
- C. Oral prednisone taperIncorrect. Oral corticosteroids are ineffective in GBS and may delay recovery.
- D. Intravenous immune globulinCorrect. IVIG (or plasma exchange) is the disease-specific treatment for Guillain-Barré syndrome.
- E. High-dose intravenous methylprednisoloneIncorrect. Glucocorticoids are not indicated in GBS; they do not hasten recovery and may worsen outcome.
Key point
Guillain-Barré syndrome is treated with IVIG or plasma exchange plus FVC monitoring; glucocorticoids are not indicated.
From the source
“Treatment includes IV immune globulin, plasma exchange, and, for severe cases, mechanical ventilation.”