To report a case of anti- GD1b IgG positive Guillain-Barre Syndrome (GBS) Variant with acute presentation of facial diplegia and preserved tendon reflexes.

Anti-GD1b IgG positive GBS is rare, and usually has an acute presentation of sensory or cerebellar ataxia with loss of tendon reflexes. Precedent Influenza virus infection is rarely reported. 

A 19 year-old female with no significant past medical history presented with acute onset of generalized body weakness, slurred speech, drooling, and facial weakness for three days. One week prior, she was diagnosed with Flu A. Examinations showed bilateral peripheral facial nerve palsy and preserved tendon reflexes. She denied other new medications, recent travel, insect or animal bites, ingestion, inhalation, or exposure to known toxic substances. 

CSF analysis revealed protein of 189 mg/dl, total nucleated cells of 2. Serology was positive for GD1b IgG antibody (52 IV). Lyme disease, sarcoidosis, meningitis, brain stem encephalitis, HIV, syphilis, HTLV, HSV, tuberculosis and vasculitis were negative in laboratory workup. MRI spine showed nerve root enhancement at cervico-thoracic levels. Nerve conduction study in bilateral legs revealed sensory-motor neuropathy.

Patient was initially treated with five days of intravenous immunoglobulin pharmacotherapy and later with physical therapy (PT). After one month facial diplegia resolved, leg weakness and sensory ataxia were evident. Patient continued to get PT and after 6 months only residual leg weakness was present.

Antibodies to GD1b ganglioside is a immune mediated neuropathy which can present with acute onset bilateral facial palsy with preserved tendon reflexes. This GBS variant can have a board spectrum of presentation as it’s ganglioside is widely distributed in the peripheral nervous system. It is important to identify and promptly treat such cases that leads to the good prognosis.