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.