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Relapse in Guillain-Barré syndrome after treatment with human immune globulin

Departments of Neurology (Drs. Irani, Cornblath, Chaudhry, and Hanley) and Anesthesiology/Critieal Care Medicine (Dr. Borel), The Johns Hopkins University School of Medicine, Baltimore, MD.

Seven adult patients received human immune globulin intravenously as initial therapy for Guillain-Barré syndrome. Although all patients initially stabilized or improved, five patients deteriorated 1 to 16 days after completion of treatment. In all five patients, clinical worsening included loss of at least one functional grade together with a decreased forced vital capacity. We subsequently treated each patient with a course of plasma exchange, which led to varying degrees of clinical improvement in four. In contrast to previously reported relapse rates for Guillain-Barré syndrome, our experience suggests that clinically significant relapses may occur in patients more often following human immune globulin therapy than after either plasma exchange or no therapy.

Address correspondence and reprint requests to Dr. D.R. Cornblath, Path 627, Johns Hopkins Hospital, Baltimore, MD 21287-6965.

Supported in part by the James P. Dunn Fund for Neuromuscular Research.

Received December 3, 1992. Accepted for publication in final form January 18, 1993.

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