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Case Reports
. 2026 Feb 26:19:579996.
doi: 10.2147/IDR.S579996. eCollection 2026.

Polymyxin-Associated Neurotoxicity: A Case of Guillain-Barré Syndrome Temporally Linked to Colistin Methanesulfonate and Respiratory Paralysis with Polymyxin B

Jiayang Huang #  1 , Juan He #  1 , Lu Li #  2 , Wangsheng Li  1 , Ke Zhang  1 , Li Ma  3 , Xiaolan Bian  1
Affiliations
Case Reports

Polymyxin-Associated Neurotoxicity: A Case of Guillain-Barré Syndrome Temporally Linked to Colistin Methanesulfonate and Respiratory Paralysis with Polymyxin B

Jiayang Huang et al. Infect Drug Resist. .

Abstract

Polymyxins are critical for multidrug-resistant Gram-negative infections, yet severe neurotoxicity remains underrecognized, within Guillain-Barré Syndrome (GBS) has not been previously reported in association with polymyxin E. We report two cases illustrating a temporal association between polymyxin therapy and severe neurological manifestations. The first is a case of polymyxin B-induced respiratory paralysis in a patient with bloodstream infection. The second represents the first reported case of GBS associated with polymyxin E (Colistin Methanesulfonate) in a patient with pneumonia; the diagnosis was confirmed electrophysiologically, and the patient responded to immunotherapy. These findings suggest a potential link between polymyxin therapy and severe, atypical neurotoxicity. Clinicians should be vigilant for symptoms ranging from acute paresthesia to GBS, as early recognition and drug discontinuation are crucial to preventing severe outcomes.

Keywords: Guillain-Barré syndrome; colistin methanesulfonate; multidrug-resistant infections; neurotoxicity; polymyxin.

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Conflict of interest statement

Jiayang Huang, Juan He and Lu Li are co-first authors for this study. The authors declare that they have no competing interests in this work.

Figures

Figure 1
Figure 1
Timeline of acute neurotoxicity following polymyxin B administration in Case 1.
Figure 2
Figure 2
Clinical course of Guillain-Barré syndrome following polymyxin E (CMS) therapy in Case 2.
See this image and copyright information in PMC

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