Liu AN, Yang JY, Chen XY, Wu SS, Ji Zhi SN, Zheng SM. Refractory Crohn's disease complicated with Guillain-Barré syndrome: A case report. World J Clin Cases 2025; 13(18): 103618 [DOI: 10.12998/wjcc.v13.i18.103618]
Corresponding Author of This Article
Shu-Mei Zheng, MD, Chief Physician, Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, No. 270 Rongdu Road, Chengdu 610083, Sichuan Province, China. zhengsm@163.com
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
A-Niu Liu, Department of Gastroenterology and Hepatology, Chengdu Medical College, Chengdu 610500, Sichuan Province, China
A-Niu Liu, Xing-Yu Chen, Shan-Shan Wu, Se-Niu Ji Zhi, Shu-Mei Zheng, Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Jia-Yi Yang, Department of Radiology, Wuxi People’s Hospital, Nanjing Medical University, Nanjing 214023, Jiangsu Province, China
Author contributions: Zheng SM designed the report; Liu AN and Chen XY collected the patient’s clinical data; Yang JY and Liu AN analyzed the magnetic resonance imaging and computed tomography images; Wu SS and Ji Zhi SN analyzed the microscopy images; Liu AN and Zheng SM wrote the paper; Yang JY edited the English language version of the manuscript; and all authors have read and approved the final version to be published.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shu-Mei Zheng, MD, Chief Physician, Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, No. 270 Rongdu Road, Chengdu 610083, Sichuan Province, China. zhengsm@163.com
Received: November 26, 2024 Revised: January 24, 2025 Accepted: February 17, 2025 Published online: June 26, 2025 Processing time: 94 Days and 2.5 Hours
Abstract
BACKGROUND
Inflammatory bowel disease (IBD) comprises a group of chronic inflammatory gastrointestinal disorders, including Crohn's disease (CD) and ulcerative colitis, with uncertain etiologies. The natural course of IBD can be accompanied by extraintestinal manifestations involving the skin, mucous membranes, musculoskeletal structures, eyes, cardiovascular system and nervous system. Guillain-Barré syndrome (GBS) is a type of peripheral neuropathy. However, the etiology and pathogenesis of IBD combined with GBS are unclear, and only a few clinical cases have been reported. Here, we report a case of refractory CD complicated by GBS and review the previous literature to improve the understanding of these diseases.
CASE SUMMARY
A 34-year-old man had a 9-year history of refractory CD. He became unresponsive to multiple drugs and experienced recurrent intestinal fistulas. After several abdominal surgeries and treatment with ustekinumab, he achieved clinical remission. Unfortunately, he developed GBS during maintenance treatment with ustekinumab. According to previous reports, in some patients with IBD combined with GBS, GBS may be a comorbidity, an extraintestinal manifestation of IBD, or an adverse reaction to IBD therapeutic drugs. After a comprehensive evaluation, we suspected that GBS might have been a comorbidity in this patient. To avoid fatal disease relapse after medication discontinuation, we concluded that ustekinumab should not be withdrawn. On the basis of a joint decision between doctors and the patient, we decided to continue maintenance treatment with ustekinumab along with intravenous immunoglobulin, dexamethasone and traditional Chinese medicine acupuncture, which resulted in a steady improvement in his GBS symptoms and sustained remission of CD.
CONCLUSION
When IBD is complicated by a neurological disease, it is first necessary to analyze the patient's condition and then choose the corresponding treatment strategy. If the neurological disease is a specific comorbidity, treatment of both IBD and the comorbid disease should be considered. For IBD patients with extraintestinal manifestations involving the nervous system, neurological manifestations tend to resolve when the active IBD is controlled. When an adverse drug reaction is suspected, the medication should be discontinued, and symptomatic treatment should be administered.
Core Tip: Inflammatory bowel disease (IBD) comprises a group of chronic inflammatory gastrointestinal disorders, including Crohn's disease (CD) and ulcerative colitis. The natural course of IBD can be accompanied by several extraintestinal manifestations. IBD combined with Guillain-Barré syndrome (GBS) has rarely been reported. Here, we describe a patient with refractory CD who stopped responding to multiple drugs and experienced recurrent complicated intestinal fistulas. After several abdominal surgeries and treatment with ustekinumab, he achieved clinical remission. Unfortunately, he developed GBS during maintenance therapy. In patients with IBD combined with GBS, GBS may be a comorbidity, an extraintestinal manifestation of IBD, or an adverse reaction to IBD therapeutic drugs. We suspected that GBS might have been a comorbidity in this patient; therefore, we decided to continue maintenance treatment with ustekinumab along with intravenous immunoglobulin, dexamethasone and traditional Chinese medicine acupuncture, which resulted in a steady improvement in his GBS symptoms and sustained remission of CD.
