GUILLAIN-BARRÉ SYNDROME WITH SUPRAVENTRICULAR TACHYCARDIA AND ALTERED SENSORIUM IN A CHILD: A RARE ATYPICAL CASE

Ashwini Angadi, Adarsh G. S.*, Sidappa F. D., Preeti V. Kulkarni, Venkatrao H. Kulkani

Guillain–Barré syndrome (GBS) is an uncommon autoimmune-mediated neurological condition that primarily affects the peripheral nervous system, resulting in acute weakness and possible paralysis. However, atypical pediatric presentations involving central nervous system features and cardiac abnormalities are rare and diagnostically challenging. We describe an unusual case of a 10-year-old female child who presented with sudden onset and progressively worsening throat pain aggravated by swallowing, along with chest pain and breathlessness. Initial electrocardiography revealed supraventricular tachycardia. There was no history of fever, respiratory symptoms, vomiting, toxin exposure, or previous similar illness. The child had normal developmental milestones and complete immunization. Clinical examination revealed mild tachycardia and elevated random blood glucose levels (213 mg/dL). Systemic evaluation showed hepatosplenomegaly and bilateral lung crepitations. Neurological assessment demonstrated altered sensorium, fixed mid-dilated pupils, and progressive decline in Glasgow Coma Scale to 6/15. Laboratory investigations showed mild leukocytosis, hyponatremia, elevated cardiac enzymes (CK-MB and troponin), and mildly increased cerebrospinal fluid protein with lymphocytic predominance in the absence of infectious organisms. Renal parameters and two-dimensional echocardiography were within normal limits. The patient’s neurological status further deteriorated with suspected non-convulsive status epilepticus. Management included antimicrobial therapy, corticosteroids, and antiepileptic treatment with levetiracetam, along with supportive care. This case illustrates a rare and complex pediatric presentation of Guillain–Barré syndrome complicated by non-convulsive status epilepticus, autonomic involvement, and metabolic derangements. It highlights the importance of early recognition of atypical features, prompt neurological intervention, and multidisciplinary management to prevent adverse outcomes in pediatric patients with unusual neurological manifestations.