Introduction
Guillain-Barré syndrome (GBS) is a classic example of a neuropathy
secondary to disordered immunity. Aberrant B cell response to
glycolipids and related conjugates results in demyelinating, axonal, or
mixed nerve damage that manifests as an acute inflammatory
immune-mediated polyneuropathy. (1) Clinical manifestations include
tingling, progressive weakness, pain, and diminished reflexes. Although
classic GBS is that of a demyelinating neuropathy with progressive
ascending weakness, several clinical variants exist, including Miller
Fisher syndrome, characterized by ophthalmoplegia and ataxia. (2)
Two thirds of GBS cases are preceded by an upper respiratory tract
infection or diarrhea, with Campylobacter jejuni the most common
etiology. (2) Vaccinations and various infectious vectors have also been
associated with GBS, including Epstein-Barr virus, cytomegalovirus,
varicella-zoster virus, mycoplasma, and, most recently, Zika virus.
(2,3)
GBS incidence following surgical procedures is unknown. Previous
national surveillance suggests that 5 percent of GBS patients had
undergone surgery within an 8-week interval before onset. (4) However,
45 percent of those patients reported an antecedent illness within that
same time period. Most recently, two retrospective case series of
patients with GBS found a 9.5 and 15 percent incidence of post-surgical
GBS. (5,6) Thus, it appears that the incidence of post-surgical GBS may
be higher than previously reported. Taken together, the most common
surgical procedures in these case series were gastrointestinal and
orthopedic; rarely patients develop GBS following coronary artery bypass
surgery. We present a rare case of GBS associated with open heart
surgery and review the extant world’s literature.