Severe Guillain-Barré syndrome associated with Campylobacter jejuni infection with failure to respond to plasmapheresis and immunoglobulin.

Guillain-Barn! syndrome is a subacute inflammatory demyelinating polyradicular neuropathy of the peripheral nerves. It is characterized by varying degrees of weakness, sensory abnormalities, and autonomic dysfunction. The cause of Guillain-Barre syndrome is not completely understood, but it is believed to be a postinfectious autoimmune disorder, because approximately two thirds of all cases are preceded by an infection, such as those caused by human immunodeficiency virus, cytomegalovirus, Epstein-Barr virus, and Campylobacter jejuni. Occasionally Guillain -Barre syndrome has been reported to come after vaccinations of various types. C jejuni infection, thought to be the most common antecedent infection to Guillain-Barre syndrome and the only bacterial infection that regularly precedes it, has been implicated in 50 to 75 percent of all cases. Culture studies have proved that a high proportion of patients with Guillain-Barre syndrome have C jejuni infection in their stools at the time of the onset of neurologic symptoms as well. We describe a case of Guillain-Barre syndrome associated with gastrointestinal C jejuni infection. This case not only highlights the clinical aspects of Guillain-Barre syndrome but also illustrates the severity of this neurologic syndrome and the lack of response to both plasmapheresis and immunoglobulin therapy.