Histological insight into the fatal case of Guillain-Barre syndrome with atypical incidental presence of Marinesco bodies and corpora amylacea: an autopsy case report

Guillain-Barre syndrome (GBS) is an inflammatory demyelinating polyneuropathy clinically characterized by ascending motor paralysis, autonomic dysfunction, and respiratory failure etc. Though generally associated with a good prognosis, a few cases may turn fatal. On autopsy, gross findings are nonspecific. Hence, autopsy diagnosis is based on clinical manifestations and histopathological examination. We report an autopsy case of GBS, which showed remarkable diagnostic features of unusual incidental neurodegenerative findings atypical for that age. A 43-year-old male presented with fever, respiratory infection, paraesthesia, and motor weakness in both upper and lower limbs. The clinical features were suggestive of GBS with autonomic system involvement; subsequently, the patient developed paralytic ileus and died due to septicemia after two weeks of treatment. Postmortem examination revealed pleural effusion, pulmonary edema, and gangrenous ileal perforation. Histopathological analysis of the brain and cranial nerves, using different special stains and IHC, confirmed demyelination, evident by loss of myelin and myelin-engulfing macrophages. In addition to changes consistent with GB syndrome, the incidental discovery of Marinesco bodies, which are typically found in neurodegenerative diseases, is noted in this case. Corpora amylacea was also reported in multiple sections of the brain and cranial nerves, which are frequent in the old age group. GBS-associated dysautonomia, leading to rare complications such as paralytic ileus, proved fatal in this case. This case gives an account of various histopathological findings that assist in the diagnosis and confirmation of GBS. It also discusses incidental neurodegenerative changes that are atypical for age and unusual in neuroinflammatory cases like GBS.