Severe Pediatric Guillain–Barré Syndrome (Aman Variant) Requiring Prolonged Mechanical Ventilation and Tracheostomy Complicated by Multidrug-Resistant Catheter-Associated Urinary Tract Infection: A Case Report

Abstract

Background: Guillain–Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in children. The acute motor axonal neuropathy (AMAN) variant is uncommon and may rapidly progress to life-threatening respiratory failure requiring prolonged intensive care. Paediatric cases complicated by prolonged mechanical ventilation, tracheostomy, and multidrug-resistant (MDR) catheter-associated urinary tract infection (CAUTI) are infrequently reported. Case Presentation: An 8-year-old boy developed rapidly ascending weakness with bilateral ptosis, bulbar palsy, and respiratory failure following a recent upper respiratory and gastrointestinal illness. Because of the acute onset, cranial nerve involvement, and respiratory impairment, neurotoxic envenomation was initially suspected, and empirical anti-snake venom was administered. However, rapidly progressive flaccid quadriparesis raised suspicion of GBS. Although initial cerebrospinal fluid (CSF) analysis and nerve conduction studies were non-diagnostic, intravenous immunoglobulin (IVIg) at 2 g/kg over 4 days was initiated within 24 hours of admission, together with ventilatory and supportive intensive care. Repeat CSF analysis and nerve conduction studies two weeks later demonstrated albuminocytological dissociation and an AMAN pattern, respectively. Because of prolonged respiratory muscle paralysis and extended ventilator dependence, tracheostomy was performed. The child subsequently developed ventilator-associated pneumonia caused by Acinetobacter spp. and Staphylococcus spp., followed by MDR Klebsiella pneumoniae CAUTI; these infections were treated with culture-guided antibiotics. Flexible endoscopic swallowing assessment identified delayed lingual and laryngeal sensation with impaired swallowing, requiring continued management before decannulation. The child gradually recovered with multidisciplinary care, including immunomodulation, ventilatory support, nutritional rehabilitation, physiotherapy, and hospital-acquired infection prevention measures. Conclusion: This case illustrates the diagnostic difficulty of severe paediatric AMAN when early investigations are non-specific and alternative diagnoses are considered. It also demonstrates the value of repeated diagnostic testing, prompt immunotherapy, multidisciplinary intensive care, and active management of hospital-acquired infections in children with severe GBS.