Abstract
Background
Acute motor and sensory axonal neuropathy is a rare, severe variant of Guillain-Barré syndrome marked by rapid progression, autonomic dysfunction, and delayed recovery. The patient in this report was treated in a resource-limited intensive care unit and had coexisting tropical infections that complicated diagnosis and treatment.
Clinical Findings
A 40-year-old man presented with acute quadriparesis, respiratory distress, and autonomic instability following a febrile illness. Laboratory tests revealed anemia, electrolyte imbalance, and methicillin-resistant Staphylococcus aureus bacteremia. Serology test results were weakly positive for dengue virus, typhoid, and scrub typhus. Nerve conduction studies confirmed acute motor and sensory axonal neuropathy.
Diagnosis
Acute motor and sensory axonal neuropathy was complicated by polyinfection and tuberculous pleuritis, confirmed via cartridge-based nucleic acid amplification testing. Imaging showed bilateral pleural effusion and right lung collapse and consolidation.
Interventions
Despite 5 cycles of intravenous immunoglobulin therapy, the patient showed no initial improvement and received 7 plasmapheresis cycles. Additional interventions included tracheostomy, vasopressors, bromocriptine for central fever, and antitubercular therapy. Nursing care grounded in the Roy Adaptation Model emphasized airway management, prevention of secondary complications, emotional reassurance, caregiver communication, and coordination of interprofessional care.
Outcomes
The patient demonstrated steady neurological improvement, was successfully weaned from ventilation, and transitioned to rehabilitation. Nurse-led, theory-informed interventions were key to patient stabilization and long-term recovery.
Conclusion
This case illustrates the complexity of acute motor and sensory axonal neuropathy with multiple infections and the role of structured nursing care for positive outcomes in intensive care units.