{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T07:40:50Z","timestamp":1768030850585,"version":"3.49.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T00:00:00Z","timestamp":1737072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Guillain-Barr\u00e9 syndrome (GBS) is a rare, immune-mediated polyneuropathy primarily affecting the peripheral nervous system. Diagnosis is often supported by neuroconduction studies showing polyradiculoneuropathy and cerebrospinal fluid (CSF) analysis revealing albumin-cytological dissociation. However, these features may not appear in the early stages, leading to potential misdiagnosis. The central nervous system (CNS) is generally not affected due to differences in antigen expression, optic neuritis (ON), a demyelinating inflammation of the optic nerve, occasionally co-occurs with GBS as a rare variant. Although GBS can manifest with various neurological symptoms, the co-occurrence of optic neuritis (ON) is rare, especially in pediatric cases. This report documents the first known case in China of a child with severe GBS complicated by ON, which developed following an upper respiratory infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>A 14-year-old male presented with acute progressive quadriparesis and visual impairment following a febrile illness. On admission, he displayed severe respiratory and autonomic instability requiring mechanical ventilation. Neurological examination revealed flaccid paralysis of all four limbs with absent reflexes, along with bilateral optic neuritis, confirmed by MRI showing inflammation of the optic nerve. Initial cerebrospinal fluid (CSF) analysis was normal, but subsequent testing revealed elevated protein levels typical of GBS. Neurophysiological studies indicated widespread demyelinating and axonal damage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions and outcomes<\/jats:title><jats:p>The patient received intravenous immunoglobulin (IVIG) therapy, high-dose corticosteroids, and, given the severe progression, rituximab. Despite initial worsening, gradual improvement in muscle strength and visual acuity was observed over several weeks. At three months, the patient was discharged with significantly restored function, with muscle strength nearing baseline and partial visual recovery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case highlights the clinical complexity of GBS with ON in pediatric patients, emphasizing the importance of timely immunomodulatory treatment. It also underscores the need for awareness of overlapping central and peripheral autoimmune neuropathies to improve diagnostic accuracy and patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2024.1517943","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T05:10:11Z","timestamp":1737090611000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Severe Guillain-Barr\u00e9 syndrome with concurrent optic neuritis in a pediatric patient: a case report"],"prefix":"10.3389","volume":"15","author":[{"given":"Xin","family":"Xue","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingcun","family":"Bao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yakun","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qun","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoling","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00517-1","article-title":"Guillain-barr\u00e9 syndrome","volume":"397","author":"Shahrizaila","year":"2021","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/jns.12594","article-title":"European Academy of Neurology\/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain\u2013Barr\u00e9 syndrome","volume":"28","author":"van Doorn","year":"2023","journal-title":"Eur J Neurol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2016.452","article-title":"Optic neuritis in Guillain-Barre syndrome","volume":"44","author":"Dayal","year":"2017","journal-title":"Can J Neurol Sci"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.15656","article-title":"Guillain-Barr\u00e9 syndrome with optic neuritis","volume":"58","author":"Andersen","year":"2022","journal-title":"J Paediatr Child Health"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.1998.tb02093.x","article-title":"Guillain-Barre\u0301 syndrome and optic neuritis after Mycoplasma pneumoniae infection","volume":"28","author":"Henderson","year":"1998","journal-title":"Aust N Z J Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-1331.2002.00350.x","article-title":"Post-infectious central and peripheral nervous system diseases complicating Mycoplasma pneumoniae infection. Report of three cases and review of the literature","volume":"9","author":"Pfausler","year":"2002","journal-title":"Eur J Neurol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1046\/j.1468-1331.2003.00659.x","article-title":"Post-infectious central and peripheral nervous system diseases in patient with Devic\u2032s disease and Guillain-Barre syndrome","volume":"10","author":"Hawley","year":"2003","journal-title":"Eur J Neurol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-004-0441-0","article-title":"Bilateral optic neuritis and Guillain-Barre\u0301 syndrome following an acute Mycoplasma pneumoniae infection","volume":"251","author":"Ginestal","year":"2004","journal-title":"J Neurol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1085-9489.2005.10313.x","article-title":"Guillain-Barre\u0301 syndrome with optic neuritis and cytomegalovirus infection","volume":"10","author":"Igarashi","year":"2005","journal-title":"J Peripher Nerv Syst"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-963674","article-title":"High-dose intravenous immunoglobulins for treatment of optic neuritis in Guillain-Barre\u0301 syndrome","volume":"224","author":"L\u0308ke","year":"2007","journal-title":"Klin Monbl Augenheilkd"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2008.12.005","article-title":"Optic neuritis and palatal dysarthria as presenting features of post-infectious GQ1b antibody syndrome","volume":"111","author":"Robbins","year":"2009","journal-title":"Clin Neurol Neurosurg"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.47.1224","article-title":"Guillain-Barre\u0301 syndrome with optic neuritis and a focal lesion in the central white matter following Epstein-Barr virus infection","volume":"47","author":"An","year":"2008","journal-title":"Intern Med"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.48.1585","article-title":"Bilateral retrobulbar optic neuritis, Guillain-Barre\u0301 syndrome and asymptomatic central white matter lesions following adult measles infection","volume":"48","author":"Tomiyasu","year":"2009","journal-title":"Intern Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"278, 341","DOI":"10.3969\/j.issn.1671-2420.2009.05.032","article-title":"A case of Guillain-Barre\u0301 syndrome complicated with optic atrophy","volume":"9","author":"Zhuang","year":"2009","journal-title":"Chin J Otorhinolaryngol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"107, 156","DOI":"10.3969\/j.issn.1673-9701.2010.03.065","article-title":"A case report of cranial neuronal Guillain-Barre\u0301 syndrome with optic neuritis","volume":"48","author":"Xie","year":"2010","journal-title":"China Modern Doctor"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.87.9.1185","article-title":"Optic neuritis in anti-GQ1b positive recurrent Miller Fisher syndrome","volume":"87","author":"Chan","year":"2003","journal-title":"Br J Ophthalmol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.survophthal.2011.10.002","article-title":"Blindness, weakness, and tingling","volume":"57","author":"Biotti","year":"2012","journal-title":"Surv Ophthalmol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1080\/01658107.2016.1237975","article-title":"A rare case of bilateral optic neuritis and Guillain-Barre\u0301 syndrome post Mycoplasma pneumoniae infection","volume":"41","author":"Baheerathan","year":"2016","journal-title":"Neuroophthalmology"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-3768.1972.tb05647.x","article-title":"Retrobulbar neuritis as an early symptom of Guillain-Barre syndrome. Report of a case","volume":"50","author":"Nikoskelainen","year":"1972","journal-title":"Acta Ophthalmol (Copenh)"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.braindev.2018.01.007","article-title":"Guillain-Barre\u0301 syndrome and optic neuritis after Mycoplasma pneumoniae infection","volume":"40","author":"Matsunaga","year":"2018","journal-title":"Brain Dev"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-018-0542-y","article-title":"Autonomic involvement in Guillain-Barr\u00e9 syndrome: an update","volume":"29","author":"Zaeem","year":"2019","journal-title":"Clin Auton Res"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.15656","article-title":"Guillain-Barre\u0301 syndrome with optic neuritis","volume":"58","author":"Andersen","year":"2022","journal-title":"J Paediatr Child Health"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.43.4.842","article-title":"Guillain-Barre\u0301 syndrome (GBS) with bilateral optic neuritis and central white matter disease","volume":"43","author":"Nadkarni","year":"1993","journal-title":"Neurology"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1080\/01658107.2022.2048861","article-title":"Guillain-barr\u00e9 Syndrome and unilateral optic neuritis following vaccination for COVID-19: A case report and literature review","volume":"46","author":"Richardson-May","year":"2022","journal-title":"Neuroophthalmology"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.4103\/aian.aian_176_22","article-title":"Optic neuritis, miller fisher syndrome, and guillain barre syndrome overlap secondary to scrub typhus in a north Indian girl","volume":"25","author":"Nagarajan","year":"2022","journal-title":"Ann Indian Acad Neurol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.17116\/jnevro2023123091106","article-title":"Sochetanie postinfektsionnogo nevrita zritel\u2019nykh nervov i sindroma Giiena\u2014Barre [Combination of post-infectious optic neuritis and Guillain-Barr\u00e9 syndrome","volume":"123","author":"Sheiko","year":"2023","journal-title":"Zh Nevrol Psikhiatr Im S S Korsakova"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.braindev.2018.01.007","article-title":"Guillain-Barr\u00e9 syndrome and optic neuritis after Mycoplasma pneumoniae infection","volume":"40","author":"Matsunaga","year":"2018","journal-title":"Brain Dev"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1177\/0883073808314360","article-title":"Simultaneous Guillain-Barr\u00e9 syndrome and acute disseminated encephalomyelitis in the pediatric population","volume":"23","author":"Bernard","year":"2008","journal-title":"J Child Neurol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1179\/1743132814Y.0000000400","article-title":"Clinical characteristics and outcomes of patients with Guillain-Barr\u00e9 and acquired CNS demyelinating overlap syndrome: a cohort study based on a literature review","volume":"36","author":"Mao","year":"2014","journal-title":"Neurol Res"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.47.1224","article-title":"Guillain-Barr\u00e9 syndrome with optic neuritis and a focal lesion in the central white matter following Epstein-Barr virus infection","volume":"47","author":"An","year":"2008","journal-title":"Intern Med"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.48.1585","article-title":"Bilateral retrobulbar optic neuritis, Guillain-Barr\u00e9 syndrome and asymptomatic central white matter lesions following adult measles infection","volume":"48","author":"Tomiyasu","year":"2009","journal-title":"Intern Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"597","DOI":"10.2165\/00003495-200464060-00003","article-title":"Guillain-Barr\u00e9 syndrome: epidemiology, pathophysiology and management","volume":"64","author":"Kuwabara","year":"2004","journal-title":"Drugs"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-006-0140-1","article-title":"Infections and vaccinations preceding childhood Guillain-Barr\u00e9 syndrome: a prospective study","volume":"165","author":"Schessl","year":"2006","journal-title":"Eur J Pediatr"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-017-2922-9","article-title":"Isolated optic neuritis associated with Mycoplasma pneumoniae infection: report of two cases and literature review","volume":"38","author":"Choi","year":"2017","journal-title":"Neurol Sci"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2018.02751","article-title":"Pathogenesis and treatment of neurologic diseases associated with mycoplasma pneumoniae infection","volume":"9","author":"D\u2019Alonzo","year":"2018","journal-title":"Front Microbiol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008630.pub5","article-title":"Pharmacological treatment other than corticosteroids, intravenous immunoglobulin and plasma exchange for Guillain-Barr\u00e9 syndrome","volume":"1","author":"Doets","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2018.0024","article-title":"Effect of treating acute optic neuritis with bioequivalent oral vs intravenous corticosteroids: A randomized clinical trial","volume":"75","author":"Morrow","year":"2018","journal-title":"JAMA Neurol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000570","article-title":"Utility and safety of rituximab in pediatric autoimmune and inflammatory CNS disease","volume":"83","author":"Dale","year":"2014","journal-title":"Neurology"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000000388","article-title":"Efficacy of rituximab as third-line therapy in combined central and peripheral demyelination","volume":"7","author":"Savasta","year":"2017","journal-title":"Neurol Clin Pract"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2024.1517943\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T05:10:15Z","timestamp":1737090615000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2024.1517943\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,17]]},"references-count":39,"alternative-id":["10.3389\/fimmu.2024.1517943"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2024.1517943","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,17]]},"article-number":"1517943"}}