[P1-125] Successful management of a 3-year-old girl with fulminant Guillain-Barré syndrome
Fulminant Guillain–Barré syndrome (GBS) is the most severe type that presents with full body paralysis in a very short time and severe dysautonomia. We report a 3-year-old girl with fulminant GBS who was successfully treated with short-acting β1-selective blocker, landiolol for circulatory failure. She presented with muscle weakness of her limbs and trunk 6 days after developing symptoms of common cold. Two days later, she experienced respiratory arrest with a Glasgow Coma Scale score of 3, necessitating endotracheal intubation. We diagnosed fulminant GBS because no abnormalities were observed on brain and spinal magnetic resonance imaging and electroencephalography, and peripheral nerve conduction velocity tests failed to evoke motor and sensory nerve action potentials. On day 3 of admission, she developed sinus tachycardia that induced circulatory failure and oliguria, which was remarkably improved with landiolol. Subsequently, we performed plasmapheresis followed by immunoglobulin and steroid pulse therapies. She was weaned off the mechanical ventilator by day 20 of admission, was ambulatory by day 44, and had completely recovered without any adverse sequelae by day 55. In conclusion, landiolol was effective for treating severe dysautonomia manifested as acute sinus tachycardia-induced circulatory failure and played a key role in saving the life of this patient.