Guillain-Barré syndrome following Plasmodium falciparum malaria in a child: a case report.

Abstract

Background: Guillain-Barré syndrome (GBS) is an acute immune‑mediated polyradiculoneuropathy and remains a leading cause of acquired neuromuscular paralysis. In children, it typically follows infection, but association with malaria is rare.

Case presentation: We report a four‑year‑old Lebanese girl living in Nigeria, who developed progressive weakness, dysphagia, inspiratory stridor, and gait ataxia 2 weeks after treatment for Plasmodium falciparum malaria. Neurological examination revealed lower‑extremity weakness with areflexia, bulbar involvement causing stridor, unilateral facial weakness, and gait ataxia (Hughes score 4). Cerebrospinal fluid analysis showed albumin‑cytologic dissociation, and nerve conduction studies demonstrated acute inflammatory demyelinating polyradiculoneuropathy. Given the rapid progression and severity, therapeutic plasma exchange (PE) was administered (five exchanges over 10 days) along with supportive care. Strength improved steadily, and at 1 month she was able to walk and run independently (Hughes score 0).

Conclusions: This case expands the limited pediatric literature on malaria-associated GBS and highlights the importance of recognizing evolving bulbar and neurological symptoms after Plasmodium falciparum infection. Early supportive care and immunotherapy may contribute to favorable neurological recovery.