Dysgeusia as an Initial Symptom of Guillain-Barré Syndrome: A Case Report and Review of the Literature

Case Diagnosis: Guillain-Barré Syndrome (GBS) presenting with isolated dysgeusia as an initial symptom prior to the development of classic neurological features.

Case Description or Program Description: We report the case of a 64-year-old woman who initially presented with isolated dysgeusia, described as a "sandpaper" and "metallic" taste, without other neurological deficits. Over the course of a week, she developed progressive bilateral lower extremity weakness, paresthesias, and areflexia, initially misdiagnosed as peripheral neuropathy. Subsequent cerebrospinal fluid analysis revealed albuminocytological dissociation, confirming GBS. She was treated with intravenous immunoglobulin (IVIG) and admitted to an acute rehabilitation unit, where she demonstrated marked clinical and functional recovery.

Setting: A tertiary care academic medical center with inpatient medicine and acute inpatient rehabilitation units.

Assessment/Results: Initial workup, including CT and MRI of the lumbar spine, ruled out spinal cord compression and discitis as causes of her progressive symptoms. Cerebrospinal fluid analysis demonstrated elevated protein without pleocytosis, consistent with GBS. Following IVIG therapy and a comprehensive rehabilitation program, the patient experienced significant improvement in strength, sensation, and functional independence, regaining ambulatory ability and self-care capacity

Discussion (relevance): This case highlights dysgeusia as a rare and atypical presenting symptom of GBS, underscoring the need for clinicians to consider GBS in patients with isolated cranial nerve symptoms, particularly when accompanied by evolving sensorimotor deficits. Early recognition of unusual GBS presentations can facilitate prompt treatment and improve patient outcomes.

Conclusions: Dysgeusia may serve as an early, underrecognized symptom of Guillain-Barré Syndrome, preceding classical neurological findings. Clinicians should maintain a high index of suspicion for GBS in patients with unexplained taste disturbances and progressive weakness to enable timely diagnosis and management. Further research is warranted to elucidate the pathophysiological mechanisms linking dysgeusia to GBS.