{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T14:13:25Z","timestamp":1779804805842,"version":"3.53.1"},"reference-count":20,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,5,5]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>A man in his 50s with poorly controlled diabetes and chronic kidney disease presented with rapidly progressive bilateral facial diplegia 1\u2009week after hospitalisation for pneumonia. Examination demonstrated symmetric lower motor neuron facial weakness without limb involvement; reflexes were 1+ throughout. Brain and internal auditory canal MRI were unremarkable. Cerebrospinal fluid showed albuminocytologic dissociation (protein 151\u2009mg\/dL, WBC 3\u2009\/mm\u00b3). Serum antiganglioside antibody testing was positive for GM2 IgG at 72 IV. CSF infectious studies were positive for West Nile virus IgM (3.07) and IgG (2.81), confirming acute neuroinvasive infection during Missouri\u2019s 2025 outbreak. The patient was treated with intravenous immunoglobulin and showed progressive improvement in facial strength, eye closure and speech, with continued recovery at 4 weeks. This case emphasises West Nile virus as a potential precipitant of facial diplegic Guillain-Barr\u00e9 syndrome.<\/jats:p>","DOI":"10.1136\/bcr-2025-271497","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T13:50:12Z","timestamp":1779803412000},"page":"e271497","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Guillain-Barr\u00e9 syndrome triggered by West Nile virus infection in Missouri\u2019s 2025 outbreak"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9072-0181","authenticated-orcid":false,"given":"Islam","family":"Aboumoussa","sequence":"first","affiliation":[{"name":"Neurology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charunetha","family":"Murugesan","sequence":"additional","affiliation":[{"name":"University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7080-9800","authenticated-orcid":false,"given":"Lily S","family":"Jafari","sequence":"additional","affiliation":[{"name":"University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mennatalah","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Alexandria University Faculty of Pharmacy, Alexandria, Alexandria Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"2026052606500709000_19.5.e271497.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00517-1"},{"key":"2026052606500709000_19.5.e271497.2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2014.121"},{"key":"2026052606500709000_19.5.e271497.3","doi-asserted-by":"publisher","DOI":"10.1074\/mcp.M115.056036"},{"key":"2026052606500709000_19.5.e271497.4","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1111\/ene.14600","article-title":"Cerebrospinal fluid protein in Guillain\u2013Barr\u00e9 syndrome: Need for age\u2010dependent interpretation","volume":"28","author":"Hegen","year":"2021","journal-title":"Euro J of Neurology"},{"key":"2026052606500709000_19.5.e271497.5","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/S0140-6736(16)00339-1","article-title":"Guillain-Barr\u00e9 syndrome","volume":"388","author":"Willison","year":"2016","journal-title":"The Lancet"},{"key":"2026052606500709000_19.5.e271497.6","doi-asserted-by":"crossref","first-page":"S74","DOI":"10.1007\/s10875-010-9407-4","article-title":"IVIG treatment and prognosis in Guillain-Barr\u00e9 syndrome","volume":"30 Suppl 1","author":"van Doorn","year":"2010","journal-title":"J Clin Immunol"},{"key":"2026052606500709000_19.5.e271497.7","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16073"},{"key":"2026052606500709000_19.5.e271497.8","doi-asserted-by":"crossref","unstructured":"Sejvar JJ . West Nile Virus Infection. Microbiol Spectr 2016;4. doi:10.1128\/microbiolspec.EI10-0021-2016","DOI":"10.1128\/microbiolspec.EI10-0021-2016"},{"key":"2026052606500709000_19.5.e271497.9","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1001\/jama.2025.8737","article-title":"West Nile Virus: A Review","volume":"334","author":"Gould","year":"2025","journal-title":"JAMA"},{"key":"2026052606500709000_19.5.e271497.10","doi-asserted-by":"publisher","DOI":"10.3201\/eid1108.050289b"},{"key":"2026052606500709000_19.5.e271497.11","doi-asserted-by":"publisher","DOI":"10.1128\/JVI.01122-06"},{"key":"2026052606500709000_19.5.e271497.12","doi-asserted-by":"crossref","unstructured":"Srichawla BS , Manan MR , Kipkorir V , et al . Neuroinvasion of emerging and re-emerging arboviruses: A scoping review. SAGE Open Med 2024;12. doi:10.1177\/20503121241229847","DOI":"10.1177\/20503121241229847"},{"key":"2026052606500709000_19.5.e271497.13","unstructured":"Missouri Department of Health and Senior Services . Human arbovirus cases - missouri 2025. 2025. Available: https:\/\/health.mo.gov\/living\/healthcondiseases\/communicable\/westnilevirus\/pdf\/HumanArbovirusCases2025.pdf"},{"key":"2026052606500709000_19.5.e271497.14","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens8040193","article-title":"Current Understanding of West Nile Virus Clinical Manifestations, Immune Responses, Neuroinvasion, and Immunotherapeutic Implications","volume":"8","author":"Bai","year":"2019","journal-title":"Pathogens"},{"key":"2026052606500709000_19.5.e271497.15","doi-asserted-by":"publisher","DOI":"10.1038\/ncpneuro0176"},{"key":"2026052606500709000_19.5.e271497.16","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2012.00037","article-title":"Neuromuscular manifestations of west nile virus infection","volume":"3","author":"Leis","year":"2012","journal-title":"Front Neurol"},{"key":"2026052606500709000_19.5.e271497.17","doi-asserted-by":"publisher","DOI":"10.3201\/eid0907.030129"},{"key":"2026052606500709000_19.5.e271497.18","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2018.01299","article-title":"Adverse Effects of Immunoglobulin Therapy","volume":"9","author":"Guo","year":"2018","journal-title":"Front Immunol"},{"key":"2026052606500709000_19.5.e271497.19","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-009-5254-8"},{"key":"2026052606500709000_19.5.e271497.20","doi-asserted-by":"publisher","DOI":"10.1002\/mus.24887"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-271497","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T13:50:15Z","timestamp":1779803415000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-271497"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":20,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,26]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bcr-2025-271497"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-271497","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}