Rapid Onset of Guillain–Barré Syndrome Following Traumatic Fracture Surgery: A case report and priming–trigger immunological hypothesis

Guillain–Barré syndrome (GBS) is an acute immune-mediated neuropathy most commonly triggered by infection. Postoperative GBS is rare, particularly with symptom onset within 24 hours. We report a 46-year-old man who developed rapidly progressive symmetric limb weakness 15 hours after surgical fixation of traumatic fractures, including a right intertrochanteric femur fracture and a right calcaneal fracture. Neurological deterioration progressed to bulbar dysfunction, autonomic instability, and respiratory failure. Electromyography demonstrated acute motor and sensory axonal neuropathy, confirming GBS. Intravenous immunoglobulin therapy was initiated, but the patient subsequently developed respiratory and cardiac arrest and required intensive care. Partial neurological recovery was observed at 30-day follow-up. The ultra-early onset and fulminant course suggest that perioperative immune imbalance and pre-existing immune priming may have accelerated autoimmune activation. Early recognition and prompt immunotherapy remain essential in postoperative patients with unexplained progressive weakness.