Severe ulcerative colitis flare precipitating Guillain–Barré syndrome: a case report and literature review

Abstract

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that can occasionally be accompanied by extraintestinal manifestations, though neurological involvement is very rare. Guillain–Barré Syndrome (GBS), an acute immune-mediated polyradiculoneuropathy, has rarely been reported in association with UC. A 45-year-old man with chronic, extensive UC (pancolitis) was observed with acute progressive flaccid paralysis that occurred after a single instance of abrupt self-discontinuation of vedolizumab. Two weeks after a severe flare of UC, he presented with ascending weakness, areflexia and diplegia of the face. Albuminocytologic dissociation was seen in CSF analysis and severe sensorimotor polyradiculoneuropathy with demyelinating features was found in nerve conduction studies, consistent with acute inflammatory demyelinating polyradiculoneuropathy (AIDP). Severe active pancolitis was found during colonoscopy. High anti-GM1 antibody levels were suggestive of an autoimmune role. Patient was treated with intravenous immunoglobulin (IVIg) and re-started on vedolizumab, where there was clinical improvement in the neurological and gastrointestinal symptoms after 10 days. Guillain–Barré syndrome could result from a severe flaring of ulcerative colitis, especially after abrupt withdrawal of biologic therapy. In UC patients, acute progressive weakness should be promptly evaluated neurologically, with early initiation of IVIg or plasma exchange, and simultaneous control of intestinal inflammation. Effective gut-directed therapy and avoiding unplanned biologic discontinuation are key to maximize clinical response.