A Child with Guillain-Barré Syndrome Presenting Paralytic Ileus.

Lee,  So Hee; Lee,  Kye Hyang

doi:2017.25.3.191

Ann Child Neurol > Volume 25(3); 2017 > Article

Case Report

Journal of the Korean Child Neurology Society 2017;25(3):191-194.
DOI: https://doi.org/10.26815/jkcns.2017.25.3.191 Published online September 30, 2017.

A Child with Guillain-Barré Syndrome Presenting Paralytic Ileus.

So Hee Lee, Kye Hyang Lee

Department of Pediatrics, School of Medicine, Catholic University of Daegu, Daegu, Korea. rosalia@cu.ac.kr

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.

Key Words: Guillain-Barré syndrome, Vomiting, Ileus