Guillain Barré syndrome in a patient without triggering factors

Introduction: Guillain Barré Syndrome is a monophasic autoimmune inflammatory polyradiculoneuropathy characterized by limb weakness. Diagnosis is based on clinical presentation, electroneuromyography and cerebrospinal fluid characteristics. Treatment is by immunotherapy with immunoglobulin or plasmapheresis. Objective: To report a case of Guillain Barré syndrome in a patient with no history of infection or recent vaccination. Methodology: This is a descriptive observational study based on the analysis of the patient's medical record and literature review. Results: Male, 80 years old, admitted to the emergency room due to weakness, pain and paresthesia in the lower limbs and hands for 20 days, associated with difficulty walking. He had no recent history of infection or vaccination. A CT scan of the skull and lumbar spine showed no alterations to justify these symptoms. Electroneuromyography met the criteria for a diagnosis of Guillain Barre syndrome. Analysis of the cerebrospinal fluid showed total proteins of 210, glucose 69, chloride 117, nucleated cells 2, red blood cells 189, VDRL not reactive and no fungal test. Due to the diagnosis of Guillain Barré, intravenous immunoglobulin was administered for 5 days in the intensive care unit, and the treatment was uneventful. After treatment with immunoglobulin, the patient returned to the ward, reporting improved strength in the lower limbs and was able to walk with support. He was discharged in a few days. In outpatient follow-up, the patient reported total improvement in symptoms. Conclusion: Although this syndrome recurs after infection or vaccination, our case was of a patient with no risk factors and typical neurological manifestations of the syndrome, with altered tests that contributed to the diagnosis and a favorable outcome.