מילות מפתח: guillain barre - bariatric surgery

אנמנזה, בדיקה גופנית, בדיקות ראשוניות:

We report a 52-year-old man with a rare GBS recurrence 15 years after a mild, Q fever–related episode in 2009. In May 2024, six months post-bariatric surgery, he developed severe ascending paralysis with areflexia and sensory loss, leading to quadriparesis and near-complete dependency in daily activities.

אבחנה מבדלת:

Acute myelopathies: Ruled out by MRI; no sensory level or hyperreflexia.
CIDP: Unlikely due to monophasic course and recovery.
Toxic/metabolic: No toxin exposure or metabolic imbalance found.
Infectious neuropathies: Serologies negative.
Neuromuscular junction disorders: No bulbar signs; EMG inconsistent.
Functional disorder: Objective neurological findings confirmed organic disease.

ממצאי בירור נוסף, בדיקות ויעוצים:

. Cerebrospinal fluid analysis showed albuminocytologic dissociation, and nerve conduction studies confirmed acute demyelinating polyradiculoneuropathy. Despite prompt IVIg treatment, the patient experienced a fulminant course with prolonged motor deficits and was non-ambulatory at 9 months, requiring bilateral orthoses and a walker. Nutritional markers remained within normal limits throughout.

אבחנה סופית:

This case highlights that Guillain–Barré Syndrome, typically a monophasic post-infectious neuropathy, can recur even after a long asymptomatic interval. Though rare (~2–6%), recurrences may follow different triggers: infection in the first episode (e.g., Q fever) and non-infectious stressors like bariatric surgery later. Proposed mechanisms include immune dysregulation or reactivation of immune memory in predisposed individuals.

מסקנות וחשיבות לרופא המשפחה:

Recurrent GBS can be as severe—or worse—than the first episode. This case shows that even after a mild GBS years earlier, surgery may trigger a severe relapse. Primary care providers must recognize this risk to ensure early referral, diagnosis, and intervention, especially in patients with a distant GBS history.