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Fulminant Guillain-Barré syndrome in a patient with systemic lupus erythematosus
  1. Eric Anthony Coomes1,
  2. Hourmazd Haghbayan1,
  3. Jenna Spring2 and
  4. Sangeeta Mehta2
  1. 1 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Eric Anthony Coomes, eric.coomes{at}


A 45-year-old man with a history of systemic lupus erythematosus presented with progressive weakness and areflexia. Electromyogram revealed reduced motor and sensory amplitudes without demyelinating features. He was clinically diagnosed with the acute motor and sensory axonal neuropathy variant of Guillain-Barré syndrome. Despite intravenous immunoglobulin therapy, he deteriorated with loss of all voluntary motor function and cranial nerve reflexes. Concomitant investigations revealed class V lupus nephritis. Therapy was initiated with plasma exchange, glucocorticoids and further immunosuppression, with gradual neurological recovery. We present the first documented case of fulminant Guillain-Barré syndrome as a neuropsychiatric manifestation of systemic lupus erythematosus, highlighting how immune-mediated polyneuropathy via diffuse deafferentation may mimic the outward appearance of brain death. While glucocorticoids are not indicated in idiopathic Guillain-Barré, when this neurological disorder is a consequence of systemic lupus erythematosus, immunomodulatory treatment should be initiated to prevent neurological deterioration.

  • immunological products and vaccines
  • intensive care
  • neurology
  • systemic lupus erythematosus
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  • Contributors EC, JS and SM cared for the patient. All authors contributed to the conception of the article. EC and HH drafted the manuscript. All authors revised the manuscript critically for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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