A sensory-predominant Guillain-Barré syndrome spectrum disorder with preserved tendon reflexes: a case report

Background Guillain-Barré syndrome (GBS) is an acute immune-mediated peripheral neuropathy that usually causes progressive limb weakness with reduced or absent tendon reflexes. Some patients, however, present mainly with sensory symptoms, mild weakness, or preserved reflexes, which can make early recognition more difficult. Case presentation A 71-year-old Han Chinese man presented with a 10-day history of distal paresthesia that became worse 2 days after diarrhea. He developed glove-and-sock sensory loss, lower-limb heaviness, gait difficulty, and mild distal weakness. Neurological examination showed reduced distal superficial sensation, preserved tendon reflexes, and no pathological reflexes. Brain MRI was unremarkable, and spinal MRI did not identify a central lesion that could explain the presentation. Cerebrospinal fluid findings showed albuminocytologic dissociation. Because neurophysiological testing was not completed during hospitalization, the working diagnosis was a clinically suspected sensory-predominant GBS-spectrum disorder. The patient received intravenous immunoglobulin together with supportive care and other adjunctive treatments, improved during hospitalization, and regained independent walking. At approximately 12-month telephone follow-up, the symptoms had largely resolved and no recurrence was reported. Conclusions When patients present after gastrointestinal infection with symmetrical distal sensory disturbance and albuminocytologic dissociation, GBS-spectrum disorders should still be considered even if weakness is mild and tendon reflexes are preserved. This case shows how difficult an atypical sensory-predominant GBS-spectrum presentation can be to recognize. Because neurophysiological testing was not completed during hospitalization and several interventions were given during the same period, treatment-specific effects cannot be determined.