Severe Guillain-Barre syndrome induced by intravitreal injection of ranibizumab for branch retinal vein occlusion: a case report.

Abstract

Background: Guillain-Barré syndrome (GBS) is an acute/subacute immune-mediated polyneuropathy characterized by varying degrees of limb or cranial nerve involvement, manifested as limb weakness, absent tendon reflexes, and sensory and autonomic dysfunction caused by demyelination and/or axonal damage of peripheral nerves and nerve roots. Upper respiratory tract infections and gastroenteritis are the most important triggering factors, but the occurrence of explosive GBS after injection of ranibizumab is very rare.

Case description: A 53-year-old female was diagnosed with left branch retinal vein occlusion (RVO) and underwent three intravitreal injections of ranibizumab (0.5 mg) in the left eye. After the third injection, she developed weakness, numbness, and tingling in the limbs, which worsened to respiratory muscle paralysis requiring mechanical ventilation and tracheostomy. Cerebrospinal fluid showed protein-cell dissociation, a positive anti-ganglioside antibody spectrum, and electromyography revealed multiple demyelinating changes in peripheral nerves. The diagnosis was GBS. After treatment with immunoglobulin (25 g) therapy, the patient improved. After two months of treatment, the tracheotomy site healed well, and the patient was able to walk independently and perform basic activities of daily living. After one year of follow-up, the patient did not experience a relapse and was basically cured. This successful outcome highlights the importance of promptly recognizing and treating GBS induced by ranibizumab, which is crucial for optimizing patient outcomes and preventing potential life-threatening consequences in patients with RVO.

Conclusions: This case underscores the potential occurrence of GBS in patients undergoing ranibizumab treatment for RVO. It highlights the importance for clinicians to promptly recognize and diagnose GBS, initiate appropriate interventions, optimize patient outcomes, and prevent potential life-threatening consequences.