Rapid Ventilator Weaning and Neuromuscular Recovery After a Single Large-Volume Therapeutic Plasma Exchange in Acute Motor Axonal Neuropathy: A Case Report

Abstract

Background. Acute motor axonal neuropathy (AMAN) is an antibody-mediated variant of Guillain-Barré syndrome (GBS) that can cause respiratory failure. Guidelines recommend a course of several therapeutic plasma exchange (TPE) sessions. Ventilator weaning after one session has rarely been reported.

Objective. To describe the clinical course, ventilator weaning, and recovery of one patient with AMAN after a single large-volume TPE session.

Methods. This case report follows the CARE guideline. A 68-year-old, previously independent man had three weeks of ascending quadriparesis. Cerebrospinal fluid showed albuminocytologic dissociation, and nerve conduction studies showed absent motor responses with preserved sensory responses. On Day 4 his Medical Research Council sum score reached a nadir of 12/60. He was intubated. On Day 5 a single TPE session exchanged 2,500 mL of plasma (1.08 plasma volumes) with albumin and saline.

Results. Dynamic lung compliance rose by 81.4% (31.7 to 57.5 mL/cmH₂O) by Day 6. He was extubated on Day 7. He left the intensive care unit on Day 8, and his GBS disability score fell from 5 to 4 at extubation and to 3 at hospital discharge on Day 21. No antibody, complement, or repeat nerve-conduction data were available.

Conclusion. In this patient, ventilator weaning and strength recovery followed a single large-volume TPE session, but one case cannot show cause or support replacing multi-session TPE. The mechanism remains hypothetical.