Matthew Nguyen, BS
Medical Student
Drexel University College of Medicine
Springfield, Pennsylvania, United States
Michael Moradi, BS
Michael Moradi
Drexel University College of Medicine
Los Angeles, California, United States
Sidharth Sahni, DO, DPT, CSCS
Resident Physician
NYU
New York, New York, United States
Harrison Jordan, DO
Resident
East Carolina University
Greenville, North Carolina, United States
Josh P. Maret, BS
Medical Student
Drexel University College of Medicine
Southampton, Pennsylvania, United States
David S. Jevotovsky, MD MBA
Resident
NYU
New York, New York, United States
Guillain Barré Syndrome Status-Post Coronary Artery Bypass Grafting
Case Description:
56-year-old male underwent elective CABG and was intubated, but failed extubation. His course was complicated by hypotension and fever of unknown origins. Patient received broad-spectrum antibiotics but remained critically ill and required ECMO. An EMG done revealed severe sensorimotor polyneuropathy with primarily axonal and a few borderline demyelinating features. EEG demonstrated no seizure activity. MRI revealed demyelination at multiple levels of the brainstem. Due to suspected GBS, lumbar puncture (LP) was done and the patient was given IVIG with improvement. Nonetheless, the patient still couldn't be weaned off the ventilator and needed a tracheostomy and PEG under general anesthesia. Post-procedure, the patient's blood cultures revealed gram-positive rods and he received Avycaz. However, the patient continued to have fevers despite antibiotics. Initially, one dose of dantrolene was given for suspected MH, but was ineffective. After extending the treatment to two doses, the fevers resolved and the patient was discharged to rehab.
Discussions:
As of 2021, 13 cases of GBS after CABG have been reported with few additional cases reported since then, highlighting the rarity of this complication. The incidence of GBS after surgery is still unknown but is a rare complication following surgery. In terms of dantrolene, the dosing for MH is 2.5 mg/kg via IV push immediately and an additional IV bolus of 1 to 2.5 mg/kg with a maximum cumulative dose of 10 mg/kg if symptoms persist.
Conclusions:
Despite the fact GBS is a rare complication following CABG, acute onset of weakness and autonomic dysfunction following surgery is an indication for workup for GBS and treatment with IVIG. Furthermore, the patient showed only minimal recovery from one dose of dantrolene. However, after receiving a second dose, his symptoms improved dramatically, highlighting the importance of administering two doses for patients with MH.
