Abstract

Background: Guillain-Barré syndrome (GBS) is an acute, rapidly progressing neurological disorder characterized by symmetrical limb weakness, loss of tendon reflexes, and autonomic dysfunction. It is typically triggered by infections, with Campylobacter jejuni and cytomegalovirus being the most common pathogens. Though Epstein-Barr virus and HIV are also known triggers, parvovirus B19 (B19V) is rarely associated with GBS. This case report presents a unique instance of GBS in a chronically HIV-infected patient, complicated by a primary B19V infection. Methods: A 63-year-old male with advanced HIV-1 infection presented with severe limb weakness, pancytopenia, and albuminocytologic dissociation. Diagnostic workup included cerebrospinal fluid (CSF) analysis, electroneuromyography (ENMG), and polymerase chain reaction (PCR) testing for neurotropic viruses. The patient was treated with intravenous immunoglobulin (IVIG). Results: CSF analysis showed elevated protein levels, and ENMG confirmed demyelinating polyradiculoneuropathy. PCR testing revealed high levels of B19V DNA in both serum and CSF, along with Epstein-Barr virus (EBV) DNA. The patient’s symptoms improved following IVIG therapy, accompanied by a significant decrease in B19V viral load. Despite clinical improvement, the patient later succumbed to a peripheral T-cell lymphoma. Conclusion: This case underscores the importance of recognizing B19V as a potential trigger for GBS, particularly in immunocompromised patients. The findings highlight the need for comprehensive viral screening in atypical GBS cases and suggest that B19V should be considered in the differential diagnosis of GBS, especially in patients with underlying HIV infection.

Keywords: Guillain-Barré Syndrome (GBS), HIV-associated neurological syndrome, Parvovirus B19 (B19V), Immunocompromised patient, Intravenous immunoglobulin (IVIG) therapy