13 September 2025
: Case report 
Guillain-Barré Syndrome Secondary to Snake Bite: A Report of a Rare and Fatal Case
Unknown etiology, Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare disease, Clinical situation which can not be reproduced for ethical reasons
Parth Mukeshbhai Dhamelia ABCDEF 1*, Dipak R. Mokariya ABDEF 1, Jaspreet Singh Anand EF 1, Pragyat Futela EF 2, Aleksandra Murawska Baptista EF 3, Abhinav Singla ABCDEF 3DOI: 10.12659/AJCR.948917
Am J Case Rep 2025; 26:e948917
Table 6 A Comparative review of post-snakebite cases in the literature, showing axonal damage in majority of the cases. AIDP with secondary axonopathy is the most common subtype, closely followed by AMAN.
| Author, Year | Age/aex | Snake apecies/Country | Post-exposure immunization | Time to onset of GBS* | Electrodiagnostic studies | Subtype of GBS | Treatment modality | Time to treatment initiation** | Outcome, time to complete recovery |
|---|---|---|---|---|---|---|---|---|---|
| Chuang et al, 1996 []11 | 36/M | Formosan krait (), Taiwan | ASV | 27 days | NCS (day 12 after admission): reduced SNAP and CMAP amplitudes, reduced conduction velocities; EMG: fibrillations and positive waves in proximal and distal limb muscles, MUAPs absent proximally but discrete distally | AMSAN* | Plasmapheresis (5 sessions over 10 days), IV methylprednisolone (500 mg/d for 5 days) | 21 days | Recovery, 9 weeks (5 weeks of Admission + 4 weeks of Rehabilitation) |
| Srivastava et al, 2010 []12 | 40/M | Unknown, India | ASV | 22 days | NCS: Absent SNAPs (median, ulnar, sural); EMG: reduced CMAP amplitudes, prolonged distal latencies, reduced velocities | AIDP with secondary axonopathy | Plasmapheresis | 20 days | Recovery, 6 months |
| Neil et al, 2012 []13 | 37/M | Vipera aspis aspis, France | – | 10 days | NCS: Slowed motor conduction with prolonged distal latencies (peroneal, cubital), slight decrease in amplitude in peroneal nerves, sensory impairment in all limbs | AIDP | Supportive care | – | Recovery, N/A |
| Neto et al, 2014 []14 | 62/M | Rattlesnake (Crotalus species), Brazil | ASV, TT | 13 days | EMG at day 60: sensory and motor axonal polyradiculoneuropathy with fibrillations in distal muscles | N/A | IVIG | N/A | Recovery, 40 days |
| Kanni et al, 2017 []15 | 60/M | Unknown, India | ASV, TT | 10 days | NCS: Prolonged F-waves, multifocal conduction blocks suggesting demyelination; repetitive stimulation normal | AIDP with secondary axonopathy | IVIG | N/A | Recovery, N/A |
| Hameed et al, 2019 []16 | 21/M | Yellow-bellied sea snake (Hydrophis platurus), Pakistan | N/A | 21 days | NCS: Reduced CMAPs (peroneal, median/ulnar), no conduction block, normal SNAPs | AMAN | Plasmapheresis (5 sessions) | 30 days | Recovery, 4 months |
| Aradhey et al, 2023 []17 | 32/M | Viper (Suspected), India | ASV, TT | 15 days | NCS: Increased distal latency, reduced conduction velocity, low CMAPs in motor nerves; normal sensory conduction | AIDP with secondary axonopathy | IVIG | N/A | Recovery, N/A |
| Changadiya et al, 2023: First Case []18 | 26/M | Common Krait, India | ASV, TT | 15 days | NCS: Demyelinating motor polyneuropathy with secondary axonal loss, sural-sparing pattern | AIDP with secondary axonopathy | IVIG (2 g/kg over 5 days) | 2–3 days (inferred) | Recovery, 6 weeks |
| Changadiya et al, 2023: Second Case []18 | 24/F | Krait (Suspected), India | ASV, TT | 10 days | NCS: Motor axonal polyneuropathy with sural-sparing; confirmed on nerve biopsy | AMAN | IVIG (2 g/kg over 5 days), Second course of IVIG at 2 months | N/A | Recovery, 3 months |
| Cakirgoz et al, 2024 []19 | 24/F | Unknown (Krait Suspected), Turkey | – | 14 days | EMG: Severe motor axonal neuropathy (Limited Data) | AMAN | Plasmapheresis (1 session) | 17 days (No Biphasic presentation) | Death, on Day 22 of Initial Admission (Refractory septic shock post-plasmapheresis) |
| Sharma et al, 2024 []20 | 19/M | Unknown (Suspected Neurotoxic Snake), India | N/A | 18 days | NCS: Severely reduced motor amplitudes, mildly slowed velocities, preserved sensory conduction | AMAN | IVIG (2 g/kg over 5 days) | N/A | Recovery, 2 months |
| Our Case | 52/M | Unknown (Krait Suspected), India | ASV, TT | 21 days | NCS: Severely reduced CMAP amplitudes and conduction velocities in lower-limb nerves, Preserved SNAPs in Sural nerve | AIDP with secondary Axonopathy | IVIG (0.4 g/kg/day – received 1 dose only) | 4 days | Death, on Day 3 of second Admission (Refractory Septic Shock Post-Aspiration Pneumonia) |
| * Calculated from the day of snake-bite event; ** Calculated from the day of onset of symptoms suggestive of GBS; GBS – Guillain-Barré syndrome; ASV – anti-snake venom; TT – tetanus toxoid vaccine; NCS – nerve conduction studies; EMG – electromyography; SNAP – sensory nerve action potential; CMAP – compound muscle action potential; MUAP – motor unit action potential; AIDP – acute inflammatory demyelinating polyneuropathy; AMAN – acute motor axonal neuropathy; AMSAN – acute motor and sensory axonal neuropathy; IVIG – intravenous immunoglobulins; N/A – data not available. | |||||||||