Guillain-Barré syndrome after living-related renal transplantation: a case report and literature review

Abstract

Guillain-Barré syndrome (GBS) is a rare but potentially life-threatening neurological complication after kidney transplantation. Diagnosis may be challenging because its presentation can mimic calcineurin-inhibitor neurotoxicity, metabolic disturbances, or infection-related neuromuscular disorders. A 34-year-old man with a living-related renal transplant performed in 2020 presented with a two-day history of progressive ascending weakness, distal paresthesia, and an inability to ambulate following a self-limited diarrheal illness. A neurological examination revealed symmetric flaccid quadriparesis and generalized areflexia. Respiratory deterioration necessitated ventilatory support, while renal allograft function remained stable throughout his hospitalization. Cerebrospinal fluid analysis demonstrated albuminocytologic dissociation, and nerve-conduction studies showed prolonged distal and F-wave latencies with reduced conduction velocities. These findings were consistent with acute inflammatory demyelinating polyradiculoneuropathy. Cytomegalovirus DNA polymerase chain reaction testing was negative. The patient received intravenous immunoglobulin (2 g/kg over 5 days), ventilatory support, and intensive rehabilitation. Progressive neurological recovery began within the first week of treatment. He was successfully weaned from ventilatory support and regained independent ambulation. At the 3-month follow-up, his motor strength had completely recovered, with preserved renal allograft function and no neurological sequelae. GBS should be considered in kidney transplant recipients presenting with acute progressive weakness, even in the absence of active cytomegalovirus infection or graft dysfunction. Early cerebrospinal fluid evaluation, electrophysiological testing, and prompt administration of intravenous immunoglobulin can result in complete neurological recovery while preserving allograft function.