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Final Program


Final Program

Multiple Sclerosis and other Neurological Conditions

205 - Guillain-Barré Syndrome with Atypical Descending Presentation Complicated by Massive Pulmonary Embolism: A Case Report

Friday, February 20, 2026
5:00 PM - 6:30 PM AST

    Presenting Author(s)

  • HA

    Hani Abdel-Rahman, DO

    Resident Physician
    Stony Brook University Hospital
    Winchester, Massachusetts, United States

    • Co-Author(s)

  • AD

    Akash Dontamsetty, DO

    Resident Physician
    Mercy Catholic Medical Center
    Gloucester city, New Jersey, United States

  • AZ

    Alex J. Zimmerman, DO

    Resident Physician
    Stony Brook
    Kings Park, New York, United States

  • BK

    Brandon Khanyan, MD

    Medical Student
    Stony Brook University Medical School
    Great Neck, New York, United States

  • SG

    Sarah Gaballah, MD

    Attending Physician
    St Charles hospital/ Stony Brook department of Medicine
    Port Jefferson, New York, United States

  • TK

    Taesung Kim, DO

    Resident
    Stony Brook University Hospital PM&R
    Manorville, New York, United States

    • Submitter(s)

  • HA

    Hani Abdel-Rahman, DO

    Resident Physician
    Stony Brook University Hospital
    Winchester, Massachusetts, United States

Case Diagnosis: Massive Pulmonary Embolism complicating Guillain-Barré Syndrome.

Case Description: A 51-year-old male with a history of hypertension, obstructive sleep apnea, and COPD presented with bilateral upper extremity paresthesia and progressive descending weakness 10 days following a diarrheal illness. He was diagnosed with Guillain-Barré Syndrome (GBS) based on clinical findings and cerebrospinal fluid analysis and received intravenous immunoglobulin (IVIG). Upon transfer to inpatient rehabilitation, he exhibited flaccid quadriparesis and impaired ambulation. While undergoing therapy, he developed acute hypotension, hypoxia, and tachycardia. Imaging revealed extensive bilateral Pulmonary Embolism (PE) with right heart strain and bilateral lower extremity Deep Vein Thrombosis (DVT), necessitating Tenecteplase administration and ICU-level care. Heparin therapy was transitioned to direct oral anticoagulation. Electromyography (EMG) confirmed sensorimotor polyneuropathy with predominantly demyelinating features. The patient returned to rehabilitation, gradually regained functional independence, and was discharged home ambulating 200 feet with a rolling walker.

Discussions: This case underscores the importance of vigilant monitoring for cardiopulmonary complications in GBS, particularly massive PE and bilateral DVTs.  Notably, treatment with (IVIG), a mainstay therapy for GBS, has been associated with an increased risk of venous thromboembolism in the literature, likely due to its pro-thrombotic properties. When combined with profound immobility and preexisting vascular comorbidities, the cumulative risk becomes clinically significant. This case reinforces the importance of early risk assessment and prophylactic strategies in the rehabilitation setting to mitigate life-threatening complications.

Conclusions:

Clinicians should maintain a high index of suspicion for thromboembolic events in patients GBS, particularly those with atypical presentations and risk factors such as immobility, vascular comorbidities, and recent IVIG therapy. Proactive screening and early implementation of thromboprophylaxis are essential during inpatient rehabilitation to prevent potentially fatal complications and optimize recovery outcomes.