Chronic inflammatory demyelinating polyneuropathy presenting with autonomic symptoms: a case report

Authors

  • Alagoma M. Iyagba Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Port Harcourt, Rivers State, Nigeria
  • Pedro C. Emem Chioma Department of Internal Medicine, University of Port Harcourt Teaching Hospital, PMB 6173, Port Harcourt, Rivers State, Nigeria

DOI:

https://doi.org/10.18203/2349-3933.ijam20170127

Keywords:

Autonomic, Chronic, Demyelinating, Inflammatory, Polyneuropathy, Symptoms

Abstract

A 31 year old female presented with a one-year history of burning sensations, numbness and tingling feelings in her hands and feet. There was also excessive sweatiness of her hands and feet while experiencing these symptoms. Her symptoms were worse at night and during hot weather conditions and aggravated by contact with light clothing. She could not tolerate her shoes. She also complained of weakness in her distal lower limbs. Examination revealed prominent wasting of the thenar and hypothenar eminences, marked bilateral weakness of hand grip, palmar, and dorsal interossei. There was also the significant weakness of the dorsiflexor of the feet with allodynia. Vibration and joint position sense were impaired in the distal lower limbs. Ankle reflexes were diminished. Nerve conduction studies showed nerve conduction block in three nerves. She also had abnormalities from motor and sensory nerve conduction studies involving multiple nerves. She showed remarkable improvements in her symptoms after a course of pulsed oral dexamethasone therapy.

References

Dalakas M. Advances in the diagnosis, pathogenesis, and treatment of chronic inflammatory demyelinating polyneuropathy. Nature Review Neurol. 2001;7(9):507-17.

Sander HW, Latov N. Research criteria for defining patients with CIDP. Neurol. 2003;60(8 Suppl 3):S8-15.

Dalakas MC. Clinical trials in CIDP and chronic autoimmune demyelinating polyneuropathies. Journal of the Peripheral Nervous System. 2012;17(s2):34-9.

Hughes R. Chronic inflammatory demyelinating polyneuropathy. Practical Neurol. 2002;2(4):198-207.

Abiodun MT, Okunola P, Ofovwe GE, Iguodala O. Chronic inflammatory demyelinating polyneuropathy: a case report and review of the literature. Ann Biomed Sci. 2013;12(1).

Bright RJ, Wilkinson J, Coventry BJ. Therapeutic options for chronic inflammatory demyelinating polyradiculoneuropathy: a systematic review. BMC Neurol. 2014;4(1):1.

Smith AG, Singleton JR. Impaired glucose tolerance and neuropathy. Neurol. 2008;14(1):23-9.

Nicolas G, Maisonobe T, Le Forestier N, Léger JM, Bouche P. Proposed revised electrophysiological criteria for chronic inflammatory demyelinating polyradiculoneuropathy. Muscle and Nerve. 2002;25(1):26-30.

Molenaar DS, Vermeulen M, De Haan R. Diagnostic value of sural nerve biopsy in chronic inflammatory demyelinating polyneuropathy. Journal Neurol, Neurosurgery and Psychiatry. 1998;64(1):84-9.

Bouchard C, Lacroix C, Plante V, Adams D, Chedru F, Guglielmi JM, et al. Clinicopathologic findings and prognosis of chronic inflammatory demyelinating polyneuropathy. Neurol. 1999;52(3):498.

Krendel DA, Parks HP, Anthony DC, St Clair MB, Graham DG. Sural nerve biopsy in chronic inflammatory demyelinating polyradiculo neuropathy. Muscle and Nerve. 1989;12(4):257-64.

Lyu RK, Tang LM, Wu YR, Chen ST. Cardiovascular autonomic function and sympathetic skin response in chronic inflammatory demyelinating polyradiculoneuropathy. Muscle and Nerve. 2002;26(5):669-72.

Lopate G, Pestronk A, Al-Lozi M. Treatment of chronic inflammatory demyelinating polyneuropathy with high-dose intermittent intravenous methylprednisolone. Archives of Neurol. 2005;62(2):249-54.

Ashman E, Gronseth G. An update on the management of chronic inflammatory demyelinating polyneuropathy. Therapeutic Advances in Neurological Disorders. 2012;5(6):359-73.

Dyck PJ, Daube J, O'Brien P, Pineda A, Low PA, Windebank AJ, et al. Plasma exchange in chronic inflammatory demyelinating polyradiculo neuropathy. New England J Med. 1986;314(8):461-5.

Hahn AF, Bolton CF, Pillay N, Chalk C, Benstead T, Bril V, et al. Plasma-exchange therapy in chronic inflammatory demyelinating polyneuropathy. Brain. 1996;119(4):1055-66.

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Published

2017-01-23