Case Report Case Series of Severe Abdominal Sepsis, AKI with Anuria and Fulminant Guillain-Barre Syndrome (GBS) Mimicking Brain Stem Death
by Salah Essa SEK1,2*, Sharaf MSM2, Mohamed MR2, Abbas MH2, Sbieh IAA2, Ahmed Esmael Mahmoud EA2
1SEHA Kidney care, SEHA, Abu Dhabi health Service Company, United Arab Emirates
2Mainat Zayed Hospital Al Dhafra, SEHA
*Corresponding author: Salah Essa SEK, SEHA Kidney care, SEHA, Abu Dhabi health Service Company, United Arab Emirates
Received Date: 18 July 2024
Accepted Date: 22 July 2024
Published Date: 26 July 2024
Citation: Salah Essa SEK, Sharaf MSM, Mohamed MR, Abbas MH, Sbieh IAA, et al. (2024) Case Series of Severe Abdominal Sepsis, AKI with Anuria and Fulminant Guillain-Barre Syndrome (GBS) Mimicking Brain Stem Death. Intern Med 8: 234. https://doi.org/10.29011/2638-003X.100134
Abstract
We describe three cases of severe abdominal sepsis complicated with anuric AKI and fulminant Guillain–Barré syndrome (GBS) mimicking brain stem death presenting between 2009 and 2023. The presence of coma, flaccid quadriplegia without sedation and absence of most of the brain stem reflexes (fixed dilated pupil, no response to light, no corneal reflex, absent cough and gag reflexes) suggests brain stem death. However, polyneuropathy in Nerve Conduction Studies (NCS), a high protein concentration in the CSF, and EEG suggested that the patient actually had GBS and all three patients recovered from GBS after receiving Therapeutic Plasma Exchange (TPE) with / without IV immunoglobulin.
Brain death determination includes exclusion of reversible cerebral injury, confounding conditions, and it is vital to perform electroencephalography (EEG) when uncertainty exists about the reliability of the clinical exam to enable appropriate early diagnosis and therapeutic management.
We report these cases as an important reminder to clinicians to consider immune mediated post infectious polyneuropathy like GBS before accepting a diagnosis of brain stem death, especially in patients with sepsis. Variant GBS can be associated with Bickerstaff brainstem encephalitis and this explains coma, loss of brain stem reflexes.
© by the Authors & Gavin Publishers. This is an Open Access Journal Article Published Under Attribution-Share Alike CC BY-SA: Creative Commons Attribution-Share Alike 4.0 International License. Read More About Open Access Policy.