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A 74-year-old female with multiple comorbidities, such as atrial fibrillation, COPD and pulmonary hypertension, developed respiratory failure resulting from pneumonia. She was treated with mechanical ventilation and vasopressors. She was referred to our hospital for exacerbation of aspiration pneumonia. Her general condition deteriorated, and she became drowsy. We administered intensive care without treatment of plasma exchange or intravenous immunoglobulin. Her condition worsened, and she became unable to maintain a sustained cough. She required tracheal intubation and mechanical ventilation. During the following 2 weeks, she developed mild muscle weakness of all extremities and respiratory paralysis. Four weeks after admission, she showed an impaired gag reflex and tongue numbness and her muscle strength deteriorated. We started plasmapheresis and intravenous immunoglobulin. However, her symptoms were not relieved; neither did they resolve spontaneously. Nerve conduction studies revealed acute axonal polyneuropathy with a slowed compound muscle action potential of the right tibial nerve. On the basis of these clinical and electrophysiological findings, we diagnosed the patient with flaccid paralysis as Guillain-Barré syndrome. After four courses of plasma exchange, she recovered without motor or respiratory deficits. The patient’s neurological symptoms remained in the chronic phase, but they did not deteriorate. This case suggests that Guillain-Barré syndrome should be included in the differential diagnosis of a patient who develops flaccid paralysis during mechanical ventilation.Donald Trump referred to

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