1627 - A Case of Recurrent Guillain–Barré Syndrome with Acute Motor Predominant Axonal Neuropathy

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CG

Connor Gifford, MD

Resident Physician
The Ohio State University
Columbus, Ohio, United States

Corresponding Author(s)

EY

Eunkyung Yu, MD

Assistant Professor
Ohio State University
Columbus, Ohio, United States

Submitter(s)

CG

Connor Gifford, MD

The Ohio State University
Columbus, Ohio, United States

Case Diagnosis: Acute motor axonal neuropathy (AMAN) is a rare subtype of Guillain–Barré syndrome (GBS) with non-inflammatory, non-demyelinating axonal degeneration.

Case Description: A 43 year old female with a history of GBS 20 years prior to admission presented to the emergency department with a one day history of progressive weakness. She initially had difficulty grasping objects with her hands which progressed to lower extremity weakness without any sensory impairments. She had a diarrheal illness approximately one week prior to the presentation. Her symptoms escalated requiring intubation for neuromuscular respiratory failure. MRI of the neuroaxis demonstrated abnormal enhancement concerning for GBS. Ganglioside antibody panel revealed a low positive titer for GM1. Electromyography and nerve conduction studies revealed normal median, ulnar, and sural sensory responses and absent left median and ulnar, bilateral peroneal, and right tibial motor responses, most consistent with AMAN. Despite plasma exchange therapy, her motor function declined to complete tetraplegia. She was unable to be weaned from mechanical ventilation.

Discussions: AMAN is a rare subtype of GBS where motor function is selectively disrupted. While recurrence of GBS is already a rare phenomenon, recurrence involving AMAN subtype is even more uncommon. This patient had a similar episode of neuromuscular weakness that spontaneously resolved twenty years prior to admission. The prognosis for AMAN is variable. This patient had poor recovery despite plasma exchange and intensive physiotherapy. Absent motor responses on electromyography combined with lack of spontaneous activity indicated widespread axonal injury which may have been an early indicator of poor functional recovery.

Conclusions: While rare, recurrent GBS can have an unpredictable course warranting early intervention, particularly in cases of AMAN. Genetic or immunologic factors may have contributed to the increased severity seen in the recurrent episode. Further study of AMAN recurrence is warranted to anticipate clinical course and develop early interventions.