Successful Therapeutic Response of Intravenous Immunoglobulin in Guillain-Barre Syndrome with Onset More Than Two Weeks: A Case Report

Authors

Ezra Immanuelly Pribadi, Master of Pharmacy Study Programme, Faculty of Pharmacy, University of Surabaya, Surabaya 60293, IndonesiaFollow
Fauna Herawati, Department of Clinical and Community Pharmacy, Faculty of Pharmacy, University of Surabaya, Surabaya 60293, IndonesiaFollow
Valentinus Besin, Faculty of Medicine, University of Surabaya, Surabaya 60293, IndonesiaFollow
Marisca Evalina Gondokesumo, Department of Clinical and Community Pharmacy, Faculty of Pharmacy, University of Surabaya, Surabaya 60293, IndonesiaFollow

Abstract

Guillain-Barré Syndrome (GBS), with a global incidence of 1–2 cases per 100,000 population annually, remains the most common cause of acute flaccid paralysis. Standard treatment includes plasma exchange within 4 weeks or intravenous immunoglobulin (IVIg) within 2 weeks of symptom onset. However, IVIg may still benefit selected late-presenting cases. Here, we report a case a 17-year-old male presented with progressive bilateral limb weakness and paresthesia that began approximately 3 weeks before admission. He also experienced a brief syncope episode and defecation syncope, indicating possible autonomic involvement. On hospital day 3, after shared decision-making, the family opted for IVIg over plasma exchange. Laboratory tests on admission and prior to IVIg showed normal albumin and elevated C-reactive protein (CRP), resulting in a low CRP-Albumin Ratio (CAR = 0.12). Although CAR has not been validated in GBS, studies in Kawasaki disease suggest that lower CAR may be associated with a favorable response to IVIg. The patient received IVIg at 0.4 g/kg/day for 5 days, starting on hospital day 4 (approximately day 24 of symptoms). By day 3 of IVIg therapy, the patient showed improved limb strength and reduced paresthesia. The GBS disability score improved from 4 to 2 upon completion of treatment. This case supports the potential benefit of IVIg beyond the conventional 2-week window in GBS, particularly in patients with autonomic symptoms. The use of CRP-Albumin Ratio (CAR) as a potential supportive marker for predicting IVIg responsiveness in GBS warrants further investigation.

DOI

10.56808/2673-060X.5557

First Page

331

Last Page

336

Recommended Citation

Pribadi, Ezra Immanuelly; Herawati, Fauna; Besin, Valentinus; and Gondokesumo, Marisca Evalina (2025) "Successful Therapeutic Response of Intravenous Immunoglobulin in Guillain-Barre Syndrome with Onset More Than Two Weeks: A Case Report," Chulalongkorn Medical Journal: Vol. 69: Iss. 5, Article 9.
DOI: https://doi.org/10.56808/2673-060X.5557
Available at: https://digital.car.chula.ac.th/clmjournal/vol69/iss5/9