Pharyngeal-Cervical-Brachial Variant of Guillain-Barré Syndrome with Neck and Shoulder Pain as the Initial Symptom: A Case Report.

Introduction: Guillain-Barré syndrome (GBS) is a type of immune-mediated acute self-limiting peripheral neuropathy. Pharyngeal-cervical brachial (PCB) is a rare variant of GBS spectrum disorder It carries a risk of misdiagnosis. To improve awareness of rare GBS variants is of importance for early recognition. Case Report: A 58-year-old woman, who initially presented with shoulder and neck pain, subsequently developed rapidly progressive limb weakness, dysphagia, and respiratory compromise and underwent a neurological evaluation including brain and cervical MRI, cerebrospinal fluid analysis, ganglioside antibody testing, and electromyography (EMG). She received supportive care and treatment with intravenous immunoglobulin (IVIG). Initial MRI findings were unremarkable. CSF analysis revealed elevated protein with mild pleocytosis, and EMG demonstrated acute motor-sensory axonal and demyelinating polyneuropathy with slowed nerve conduction. Following IVIG therapy, the patient's respiratory function stabilized, motor strength gradually recovered, and she resumed walking after 2 months. One-year follow-up indicated full clinical recovery and improved EMG findings. Conclusion: This case underscores the necessity of recognising and addressing rare Guillain-Barré variants with similar presentations in clinical settings.