Guillain-Barré Syndrome in Pregnancy: An Unusual Case
A 29-year-old primigravida started with pain and mild heaviness in the both lower limbs distally associated with occasional pins and needles sensation in 35th week of pregnancy. Her symptoms were progressive. Over the next 10 days, the patient noticed knee buckling with frequent falls and difficulty in sitting and standing from supine position. At the end of 36th week, an emergency LSCS (lower segment caesarian section) was performed for decreased fetal heart rate. LSCS was uneventful and a healthy baby was born. Second post-partum day, the patient was discharged. On third post-partum day, the patient complained of weakness all the four limbs (in addition to persisting symptoms), more in lower limbs and was not able to maintain the erect posture. In this state, the patient was brought to our accident and emergency department. A detailed history was taken which revealed initiation of symptoms during third trimester of pregnancy without any preceding illness. Subsequent clinical examination revealed sinus tachycardia, fluctuating hypertension, power of 4/5 in upper limbs, 3/5 in lower limbs, hypotonia, areflexia (lower limbs), flexor plantar response, and mild involvement of all the modalities of sensation. A working diagnosis of GBS was made and all other investigations including nerve conduction studies, arterial blood gases, electrolytes, and later cerebrospinal fluid analysis were planned.\nArterial blood gas analysis showed pO2=89 mmHg, saturation = 94.6%, pCO2=42 mmHg, and pH = 7.39. Serum potassium was 4.1 meq/L, sodium 136 meq/L and bicarbonate 25 meq/L. Electrocardiography showed sinus tachycardia and routine blood chemistry was normal. Serological tests for campylobacter jejuni, EBV, cytomegalovirus, and mycoplasma pneumonae were negative. Electrophysiological studies revealed decreased amplitude of compound action potentials in median and common peronial nerves with decreased conduction velocity and abnormal F waves. After 7 days, lumbar puncture was performed and cerebrospinal fluid chemistry revealed raised protein of 7.8 g/L and normal cell count, confirming the diagnosis. The patient received treatment in the form of physiotherapy and close observation of symptoms and signs to which she rapidly responded with respect to power and sense of well-being over next 72 h, without the intervention of immunomodulating drugs. Sinus tachycardia and episodic hypertension was treated with atenolol. The patient was discharged after 2 weeks of hospital stay with power of 5/5 in upper limbs, 4+/5 in right lower limb, and 4/5 in left lower limb with persisting areflexia in lower limbs.