31-Year-Old Postpartum Woman with Acute Neurological Deterioration

Case at a Glance

A 31-year-old woman, 3 months postpartum, presented with acute onset of neurological symptoms including bowel and bladder incontinence, sensory loss, and progressive weakness, ultimately diagnosed with Guillain-Barré Syndrome following a gastrointestinal infection.

Patient's Story

The patient initially presented to her primary care physician several weeks prior with concerns about possible multiple sclerosis, reporting sudden onset of tingling in hands and feet, pins and needles sensations, and a general feeling of decreased motor control. Her physician ordered comprehensive blood work to rule out vitamin deficiencies, which returned normal results. The patient had given birth 3 months earlier and experienced a gastrointestinal illness approximately 2 weeks before symptom onset. Her symptoms acutely worsened when she developed complete loss of sensation in her bowel and bladder with associated incontinence, along with numbness in her back and inability to feel light touch.

Initial Assessment

Upon emergency department presentation, the patient was immediately triaged due to the severity of her neurological symptoms. Physical examination revealed diminished reflexes in the lower extremities and sensory deficits. The combination of bowel/bladder dysfunction, sensory loss, and progressive weakness in a postpartum patient with recent gastrointestinal illness raised suspicion for acute neurological conditions requiring immediate evaluation.

The Diagnostic Journey

Initial differential diagnosis included cauda equina syndrome, transverse myelitis, multiple sclerosis, and Guillain-Barré Syndrome. The patient underwent urgent MRI imaging of the brain and spine. When questioned about family history, the patient revealed that another family member had recently been diagnosed with Campylobacter jejuni infection. This critical piece of information, combined with the clinical presentation and timeline following gastrointestinal illness, led to focused testing for Guillain-Barré Syndrome.

Final Diagnosis

Guillain-Barré Syndrome (GBS) secondary to Campylobacter jejuni infection. The diagnosis was confirmed through clinical presentation, nerve conduction studies, and cerebrospinal fluid analysis showing characteristic albuminocytologic dissociation.

Treatment Plan

The patient was admitted for inpatient management and initiated on a 5-day course of intravenous immunoglobulin (IVIG) therapy. Supportive care included monitoring for respiratory compromise, physical therapy consultation, and bladder management. The treatment team coordinated care considering her status as a new mother with a 3-month-old infant at home.

Outcome and Follow-up

The patient experienced rapid progression of symptoms with complete lower extremity weakness developing during hospitalization, requiring assistance with ambulation. Upper extremity function remained intact initially. She was closely monitored for respiratory involvement and received comprehensive rehabilitation support. Long-term follow-up was arranged for neurological recovery assessment and gradual return to baseline function, which typically occurs over months in GBS cases.