Guillain-Barré Syndrome As the Initial Manifestation of Human Immunodeficiency Virus Infection: A Case Report

Abstract

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy typically triggered by an antecedent infection. Human immunodeficiency virus (HIV) is an uncommon but recognized association, and GBS may rarely constitute the first clinical manifestation of previously undiagnosed HIV infection. A 36-year-old man presented with subacute facial diplegia, predominantly distal tetraparesis, sensory ataxia, glove-and-stocking paresthesia, and hyporeflexia. Cerebrospinal fluid (CSF) analysis showed albuminocytologic dissociation; electrophysiological studies demonstrated a sensorimotor polyradiculoneuropathy with prominent demyelinating features, supporting the diagnosis of GBS. He received a five-day course of intravenous immunoglobulin (IVIG) with initial modest improvement followed by subsequent marked neurological deterioration and respiratory failure requiring invasive mechanical ventilation and a second IVIG course. Etiological investigation revealed previously undiagnosed HIV-1 infection and concomitant syphilis. Antiretroviral therapy was initiated, and presumptive neurosyphilis was treated with ceftriaxone. The patient developed autonomic instability and required tracheostomy for prolonged ventilatory weaning. He was transferred after an 89-day hospital stay with residual tetraparesis, predominantly affecting the lower limbs. GBS may be the initial presentation leading to the diagnosis of previously unrecognized HIV infection. Concomitant syphilis added diagnostic complexity, requiring integration of clinical, electrophysiological, CSF, microbiological, and serological findings and cautious causal interpretation. This case supports considering HIV testing in otherwise unexplained acute inflammatory polyradiculoneuropathy and highlights the potential severity of HIV-associated GBS, including autonomic and respiratory complications.