A 24-year-old woman presents with bilateral lower limb weakness, ascending over 3 days, absent deep tendon reflexes and facial diplegia, preceded by a campylobacter gastroenteritis 2 weeks earlier. CSF shows albuminocytological dissociation. Nerve conduction studies show prolonged distal motor latencies, reduced CMAP amplitudes with conduction block. The MOST appropriate immediate treatment is:
- A High-dose corticosteroids
- B IV immunoglobulin (IVIG) 0.4 g/kg/day for 5 days or plasma exchange ✓
- C Rituximab for anti-GQ1b antibody positivity
- D Pyridostigmine for neuromuscular junction blockade
Correct answer: B. IV immunoglobulin (IVIG) 0.4 g/kg/day for 5 days or plasma exchange
Explanation
This is classic Guillain-Barré syndrome (AIDP variant) with post-infectious demyelination. The two proven disease-modifying treatments are IVIG (0.4 g/kg/day × 5 days) or plasma exchange (5 exchanges over 2 weeks); they are equally effective and not additive. Corticosteroids are contraindicated in GBS as they do not improve outcome and may worsen it (CLASS trial). Rituximab is used in anti-MAG neuropathy or multifocal motor neuropathy. Pyridostigmine is for myasthenia gravis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.