CASE REPORT article
Front. Pediatr.
Sec. Pediatric Critical Care
Volume 13 - 2025 | doi: 10.3389/fped.2025.1610035
This article is part of the Research TopicCase Reports in Intensive Care Cardiovascular Medicine: 2025View all 4 articles
Case report: Post-surgical Guillain-Barré syndrome as a rare differential diagnosis of flaccid paralysis of the lower extremities in an infant after cardiac surgery
Provisionally accepted
- 1Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tuebingen, Tübingen, Baden-Württemberg, Germany
- 2Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Tübingen, Germany
- 3Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital Tübingen, Tübingen, Germany
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Introduction: Guillain-Barré syndrome (GBS) is an important cause of flaccid paralysis in children and is mainly associated with antecedent infections. Surgery as an additional trigger for GBS is a welldocumented phenomenon in adults, but is significantly less reported in pediatric patients. This case report describes an infant with post-surgical GBS following cardiac surgery, highlighting the diagnostic challenges and differential diagnoses of post-surgical GBS in the pediatric intensive care setting.A former extremely preterm infant with congenital cytomegalovirus (CMV) infection underwent a second surgery for re-coarctation of the aorta with aortic arch hypoplasia at the chronological age of six months. While requiring extracorporeal membrane oxygenation postoperatively, the girl presented with flaccid paralysis of the lower extremities. Magnetic resonance imaging of the brain, spine, and nerve conduction studies demonstrated findings consistent with acute motor-sensory axonal neuropathy-type GBS. She was treated with intravenous immune globulin and ganciclovir due to CMV reactivation (plasma 14,000 copies/mL). Gradual neurological improvement was noted over the following months, while persistent motor deficits remained, suggesting potential disease transition into chronic inflammatory demyelinating polyneuropathy.Conclusions: This case report emphasizes the importance of considering post-surgical GBS in critically ill children with postoperative paralysis. Recognition may be delayed due to variable initial presentations and accompanying factors such as sedation and extracorporeal life support.
Keywords: Pediatric Guillain-Barré syndrome, Post-surgical flaccid paralysis, Coarctation, case report, cytomegolovirus
Received: 11 Apr 2025; Accepted: 26 May 2025.
Copyright: © 2025 Gross, Berger, Neunhoeffer, Nordmeyer and Bevot. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Maximilian Gross, Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tuebingen, Tübingen, 72016, Baden-Württemberg, Germany
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