Acute-onset chronic inflammatory demyelinating polyneuropathy with cranial nerve involvement, dysautonomia, respiratory failure, and autoantibodies

Muscle Nerve. 2010 Mar;41(3):423-6. doi: 10.1002/mus.21543.

Abstract

We examined a 27-year-old woman who developed rapidly progressive quadriplegia and acute respiratory failure that required mechanical ventilation in the intensive care unit. It was unclear whether this was a presentation of Guillain-Barré syndrome (GBS) or acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP). Remarkable features included multiple cranial nerve involvement, respiratory failure, dysautonomia, and skin manifestations. Several autoantibodies were elevated, including antinuclear (ANA), anticardiolipin (aCL), thyroid, and calcium-sensing receptor (CaSR) autoantibodies. The patient was initially diagnosed with GBS and treated with intravenous immunoglobulin (IVIg). After almost complete recovery, relapse with quadriplegia and respiratory failure was observed 12 weeks after motor symptom onset. She then received IVIg and steroid pulse therapy followed by maintenance oral methylprednisolone and plasma exchange. She recovered completely 4 months after the relapse. The further clinical and serological course was consistent with systemic lupus erythematosus (SLE)-associated CIDP. Herein we evaluate the association between A-CIDP and some biological markers of autoimmunity.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / therapeutic use
  • Autoantibodies / immunology*
  • Cranial Nerve Diseases / immunology*
  • Cranial Nerve Diseases / therapy
  • Diagnosis, Differential
  • Disease-Free Survival
  • Electrodiagnosis
  • Female
  • Guillain-Barre Syndrome / diagnosis*
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Lupus Erythematosus, Systemic / diagnosis*
  • Lupus Erythematosus, Systemic / immunology
  • Lupus Erythematosus, Systemic / therapy
  • Methylprednisolone / therapeutic use
  • Neural Conduction / physiology
  • Plasma Exchange
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / diagnosis*
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / immunology
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / therapy
  • Primary Dysautonomias / immunology*
  • Primary Dysautonomias / therapy
  • Quadriplegia / immunology
  • Quadriplegia / therapy
  • Respiration, Artificial
  • Respiratory Insufficiency / immunology*
  • Respiratory Insufficiency / therapy
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Autoantibodies
  • Immunoglobulins, Intravenous
  • Methylprednisolone