One trigger, two systems: post-infectious severe Guillain-Barre syndrome with concurrent central nervous system demyelination”: a case report

Abstract

Combined central and peripheral demyelination is a rare but serious neurological condition that is associated with poor outcomes. We report a 31-year-old male presenting with rapidly progressive Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) variant of Guillain–Barré syndrome following an upper respiratory tract infection. The course was complicated by respiratory failure requiring intubation and significant autonomic dysfunction. Despite treatment with intravenous immunoglobulin, there was minimal clinical improvement. Further imaging of the central nervous system revealed multiple acute demyelinating lesions involving the brain and spinal cord. The patient subsequently received plasmapheresis and high-dose intravenous steroids without significant neurological recovery. A severe hospital-acquired infection delayed rituximab initiation until four months after symptom onset; however, neurological recovery remained minimal. This case highlights the rare coexistence of post-infectious central and peripheral demyelination. Early recognition of central involvement in patients with poor response to standard GBS therapy may help guide escalation of immunotherapy and potentially improve outcomes.