Guillain-Barre Syndrome in A Patient with Infectious Endocarditis: Clinical Observation and Literature Review
E. V. Reznik,
P. A. Mogutova,
M. Kh. Shurdumova,
E. V. Astashkevich,
A. L. Lukyanov,
L. M. Mikhaleva,
K. Yu. Midiber,
A. P. Smirnov,
G. N. Golukhov https://doi.org/10.20514/2226-6704-2025-15-4-310-320
EDN: UPWBRQ
Abstract
Guillain-Barré Syndrome is a severe autoimmune disease of the peripheral nervous system, representing the most common cause of acute flaccid tetraparesis, which can lead to life-threatening respiratory failure in the absence of adequate therapy. The relationship between GBS and infective endocarditis is not well studied.
A 54-year-old patient experienced increasing numbness and weakness in the lower extremities two weeks after an acute respiratory viral infection, and was hospitalized with suspected ischemic stroke. Brain computed tomography revealed no data for acute focal pathology but showed left-sided sinusitis and ethmoiditis. Cerebrospinal fluid analysis showed protein at 0.8 g/L (normal up to 0.2 g/L), with cytosis within normal limits. The neostigmine test was negative. The clinical and instrumental picture was assessed as Guillain-Barré Syndrome. Echocardiography revealed vegetations on the mitral valve (MV) leaflets, rupture of the anterior leaflet chordae (“flail leaflet” of the MV), and grade 3 mitral regurgitation. Despite ongoing therapy, including antibacterial and immunomodulatory treatment, the patient continued to exhibit neurological symptoms, developed pulmonary artery thromboembolism, nosocomial bilateral polysegmental pneumonia, and sepsis, leading to a fatal outcome. Autopsy confirmed infective endocarditis with rupture of the MV chordae, abundant growth of Pseudomonas aeruginosa, scant growth of Klebsiella pneumoniae and Acinetobacter baumannii, and right atrial thrombosis. No pathological changes were found in the brain substance.
Thus, Guillain-Barré Syndrome in rare cases can be associated with infective endocarditis and negatively impact the course and prognosis of the disease.
Supporting agencies: The authors declare no funding for this study
About the Authors
E. V. Reznik
FSAEI HE N.I. Pirogov RNRMU of MOH of Russia; City Clinical Hospital № 31 named after academician G.M. Savelieva of Healthcare Department of Moscow
Russian Federation
Competing Interests:
Russian Federation
Reznik Elena Vladimirovna — MD, PhD, Head of the Department of Internal disease Propedeutics № 2 of Institute of Clinical Medicine; Cardiologist
Moscow
Competing Interests:
The authors declare no conflict of interests
P. A. Mogutova
FSAEI HE N.I. Pirogov RNRMU of MOH of Russia
Russian Federation
Competing Interests:
Russian Federation
Polina A. Mogutova — C. Sc. (Med.), PhD of the Department of Internal disease Propedeutics № 2 of Institute of Clinical Medicine
Moscow
Competing Interests:
The authors declare no conflict of interests
M. Kh. Shurdumova
FSAEI HE N.I. Pirogov RNRMU of MOH of Russia; City Clinical Hospital № 31 named after academician G.M. Savelieva of Healthcare Department of Moscow
Russian Federation
Competing Interests:
Russian Federation
Marina Kh. Shurdumova — C . Sc. (Med.), Head of the depar tment of neurology for patients with stroke; PhD of the Department of Neurology, Neurosurgery and Medical Genetics of Institute of Neuroscience and Neurotechnology
Moscow
Competing Interests:
The authors declare no conflict of interests
E. V. Astashkevich
FSAEI HE N.I. Pirogov RNRMU of MOH of Russia
Russian Federation
Competing Interests:
Russian Federation
Egor V. Astashkevich — student of the Russian national research medical University
Moscow
Competing Interests:
The authors declare no conflict of interests
A. L. Lukyanov
FSAEI HE N.I. Pirogov RNRMU of MOH of Russia; City Clinical Hospital № 31 named after academician G.M. Savelieva of Healthcare Department of Moscow
Russian Federation
Competing Interests:
Russian Federation
Andrey L. Lukyanov — C. Sc. (Med.), head of the department of resuscitation and intensive care for patients with stroke; PhD of the Department of Neurology, Neurosurgery and Medical Genetics named after academician L.O. Badalyan of the Institute of Neuroscience and Neurotechnology
Moscow
Competing Interests:
The authors declare no conflict of interests
L. M. Mikhaleva
City Clinical Hospital № 31 named after academician G.M. Savelieva of Healthcare Department of Moscow; Avtsyn Research Institute of Human Mor phology of Federal state budgetary scientific institution “Petrovsky National Research Centre of Surgery
Russian Federation
Competing Interests:
Russian Federation
Liudmila M. Mikhaleva — corresponding member of the Russian Academy of Sciences, MD, Professor, Director of the Avtsyn Research Institute of Human Morphology; Head of the pathological department Moscow
Moscow
Competing Interests:
The authors declare no conflict of interests
K. Yu. Midiber
City Clinical Hospital № 31 named after academician G.M. Savelieva of Healthcare Department of Moscow; Avtsyn Research Institute of Human Mor phology of Federal state budgetary scientific institution “Petrovsky National Research Centre of Surgery”
Russian Federation
Competing Interests:
Russian Federation
Konstantin Yu. Midiber — C. Sc. (Med), pathologist; Head of the group of pathomorphological and immunihistochemical studies, Reference center
Moscow
Competing Interests:
The authors declare no conflict of interests
A. P. Smirnov
FSAEI HE N.I. Pirogov RNRMU of MOH of Russia; City polyclinic No. 212 of the Moscow Department of Health
Russian Federation
Competing Interests:
Russian Federation
Andrey P. Smirnov — C. Sc. (Med.), Chief freelance specialist of the Department of Health at ZAO in neurology, neurologist of the highest qualifi cation category, functional diagnostics doctor, Chief Physician; PhD of the department of neurology, neurosurgery and medical genetics of the Institute of Neuroscience and Neurotechnology
Moscow
Competing Interests:
The authors declare no conflict of interests
G. N. Golukhov
City Clinical Hospital № 31 named after academician G.M. Savelieva of Healthcare Department of Moscow
Russian Federation
Competing Interests:
Russian Federation
Georgy N. Golukhov — MD, Professor, Corresponding Member of the Russian Academy of Sciences, President
Moscow
Competing Interests:
The authors declare no conflict of interests
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For citations:
Reznik E.V., Mogutova P.A., Shurdumova M.Kh., Astashkevich E.V., Lukyanov A.L., Mikhaleva L.M., Midiber K.Yu., Smirnov A.P., Golukhov G.N. Guillain-Barre Syndrome in A Patient with Infectious Endocarditis: Clinical Observation and Literature Review. The Russian Archives of Internal Medicine. 2025;15(4):310-320. (In Russ.) https://doi.org/10.20514/2226-6704-2025-15-4-310-320. EDN: UPWBRQ
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