Presumed oxaliplatin-related Guillain-Barré syndrome: A case report and review of chemotherapy-related Guillain-Barré syndrome.
- 1Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI.
- 2Department of Oncology, Barbara Ann Karmanos Cancer Center, Detroit, MI.
Abstract
Rationale
Oxaliplatin, a platinum-based chemotherapeutic widely used in colorectal, hepatobiliary, and pancreatic malignancies, commonly causes a symmetric, cold-induced sensory neuropathy. Rarely, it has been linked to immune-mediated Guillain-Barré Syndrome (GBS), which can be misattributed to drug-induced sensory neuropathy and delay diagnosis. Distinguishing the two is critical because GBS can progress to respiratory failure and death.Patient concerns
A 77-year-old woman with concurrent metastatic cholangiocarcinoma and colorectal carcinoma developed acute, symmetric, ascending motor weakness with clinically preserved sensation approximately 2 weeks after her last cycle of gemcitabine, oxaliplatin, leucovorin, and 5-fluorouracil (GOLF), rapidly progressing to an inability to ambulate.Diagnosis
Neurological examination and cerebrospinal fluid analysis (albuminocytologic dissociation) were consistent with GBS, and nerve conduction studies demonstrated absent motor and sensory responses, indicating a severe axonal variant (AMSAN); sensory involvement was electrodiagnostic rather than clinical. An extensive infectious, autoimmune, and paraneoplastic workup was negative, supporting a diagnosis of presumed oxaliplatin-related GBS; a Naranjo score of 4 indicated a "possible" drug association.Interventions
She received 5 sessions of therapeutic plasma exchange followed by 4 sessions of intravenous immunoglobulin.Outcomes
No meaningful neurological recovery occurred; she developed progressive respiratory failure requiring mechanical ventilation and died.Lessons
Clinicians should maintain a high index of suspicion for GBS in patients on platinum-based chemotherapy who develop abrupt, symmetric motor weakness after common causes have been ruled out. Because causality is difficult to establish, the association remains presumed; early recognition, prompt immunotherapy, and pharmacovigilance are essential to reduce mortality.
Related
- Hyperacute Guillain-Barré Syndrome: A Pathophysiological Interpretation
- Acute-Onset Chronic Inflammatory Demyelinating Polyneuropathy May Manifest as Recurrent Guillain-Barré Syndrome of a Severe Refractory Case
- Efgartigimod in the treatment of severe Guillain–Barre syndrome with overlapping autoantibody syndrome: a case report and updated clinical review
- Reply to the Letter “Acute-Onset Chronic Inflammatory Demyelinating Polyneuropathy May Manifest as Recurrent Guillain-Barré Syndrome of a Severe Refractory Case”
- Guillain-Barré Syndrome in Late Pregnancy Following Respiratory Syncytial Virus Infection: A Diagnostic Dilemma.
BibTeX
@article{chohan2026presumed,
title = {{Presumed oxaliplatin-related Guillain-Barré syndrome: A case report and review of chemotherapy-related Guillain-Barré syndrome.}},
author = {Sikander Chohan and Muhammad Wasif Saif},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051121},
url = {https://europepmc.org/article/MED/42888581},
note = {CC BY},
}
RIS
TY - JOUR
TI - Presumed oxaliplatin-related Guillain-Barré syndrome: A case report and review of chemotherapy-related Guillain-Barré syndrome.
AU - Sikander Chohan
AU - Muhammad Wasif Saif
PY - 2026
DA - 2026/10/01
JO - Medicine
DO - 10.1097/md.0000000000051121
UR - https://europepmc.org/article/MED/42888581
AB - Rationale Oxaliplatin, a platinum-based chemotherapeutic widely used in colorectal, hepatobiliary, and pancreatic malignancies, commonly causes a symmetric, cold-induced sensory neuropathy. Rarely, it has been linked to immune-mediated Guillain-Barré Syndrome (GBS), which can be misattributed to drug-induced sensory neuropathy and delay diagnosis. Distinguishing the two is critical because GBS can progress to respiratory failure and death.Patient concerns A 77-year-old woman with concurrent metastatic cholangiocarcinoma and colorectal carcinoma developed acute, symmetric, ascending motor weakness with clinically preserved sensation approximately 2 weeks after her last cycle of gemcitabine, oxaliplatin, leucovorin, and 5-fluorouracil (GOLF), rapidly progressing to an inability to ambulate.Diagnosis Neurological examination and cerebrospinal fluid analysis (albuminocytologic dissociation) were consistent with GBS, and nerve conduction studies demonstrated absent motor and sensory responses, indicating a severe axonal variant (AMSAN); sensory involvement was electrodiagnostic rather than clinical. An extensive infectious, autoimmune, and paraneoplastic workup was negative, supporting a diagnosis of presumed oxaliplatin-related GBS; a Naranjo score of 4 indicated a "possible" drug association.Interventions She received 5 sessions of therapeutic plasma exchange followed by 4 sessions of intravenous immunoglobulin.Outcomes No meaningful neurological recovery occurred; she developed progressive respiratory failure requiring mechanical ventilation and died.Lessons Clinicians should maintain a high index of suspicion for GBS in patients on platinum-based chemotherapy who develop abrupt, symmetric motor weakness after common causes have been ruled out. Because causality is difficult to establish, the association remains presumed; early recognition, prompt immunotherapy, and pharmacovigilance are essential to reduce mortality.
SN - 0304-5412
SN - 1536-5964
ER -