CHEST Guidelines-A-48-Year-Old-Man-With-Excessive-Drooling-and-Desc

A-48-Year-Old-Man-With-Excessive-Drooling-and-Desc

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A 48-year-old man with worsening dysphagia and symptoms like excessive drooling, weak speech, and upper extremity weakness was hospitalized. His symptoms followed an upper respiratory tract infection treated with antibiotics. Initial examination found he had normal vital signs, was alert, but showed cranial nerve impairments, notably in the head and neck region. Quickly after, the patient experienced descending paralysis requiring mechanical ventilation due to acute respiratory failure. Diagnostic tests ruled out infections and other conditions such as myasthenia gravis, as well as botulism. The electromyography and nerve conduction studies pointed to acute motor axonal peripheral neuropathy. Based on these findings and clinical presentation, the diagnosis of the pharyngeal cervical brachial (PCB) variant of Guillain-Barré syndrome (GBS) was considered. <br /><br />GBS, a post-infectious immune-mediated condition, involves nerve damage leading to paralysis. The PCB variant, responsible for approximately 3% of GBS cases, specifically affects muscles in the neck and upper body. It often follows respiratory infections. GBS, including PCB variants, can often be diagnosed with clinical examination and history alone, emphasizing early treatment application to improve outcomes. PCB, specifically, may present ambiguously alongside MFS or Bickerstaff encephalitis when symptoms like ataxia or altered consciousness occur.<br /><br />The patient received intravenous immunoglobulin (IVIG) treatment, which led to muscle strength recovery and subsequent discharge to a rehabilitation facility. The report highlights the necessity for quick diagnosis and treatment to avoid complications like respiratory failure and extended ICU stays. Despite extensive testing, a diagnosis could have been confidently made initially, reinforcing the role of clinical judgment.

Keywords

Guillain-Barré syndrome

pharyngeal cervical brachial variant

dysphagia

descending paralysis

acute motor axonal neuropathy

intravenous immunoglobulin

respiratory failure

cranial nerve impairments

post-infectious condition

immune-mediated