Objective
In certain situations, severe forms of Guillain-Barré syndrome (GBS) show no response or continue to deteriorate after intravenous immunoglobulin (IVIg) infusion. It is unclear what the best treatment option would be in these circumstances.
Method
This is a case report on patients with severe axonal GBS in whom a second cycle of IVIg was used.
Results
Three patients on mechanical ventilation who presented axonal variants of GBS, with autonomic dysfunction, bulbar impairment and Erasmus score > 6, showed no improvement after IVIg infusion of 400 mg/kg/d for 5 days. After 6 weeks, we started a second cycle of IVIg using the same doses and regimen as in the previous one. On average, 5 days after the second infusion, all the patients were weaned off mechanical ventilation and showed resolution of their blood pressure and heart rate fluctuations.
Conclusions
A second cycle of IVIg may be an option for treating severe forms of GBS.
Guillain-Barré syndrome; acute inflammatory demyelinating polyradiculoneuropathy; flaccid acute paralysis; immunotherapy; immunoglobulin
