(Kiosk 4) Unique Case of Idiopathic Acute Inflammatory Demyelinating Polyneuropathy in a 31 Year Old Male

Case Diagnosis: idiopathic acute inflammatory demyelinating polyneuropathy

Case Description or Program Description: A 31-year-old male presented with sensory disturbances and muscle weakness, which progressed over 3.5 weeks. The patient reported no inciting events other than tooth extraction 2 months prior. Initial symptoms included tingling in the hands and feet followed by painful sensations. Dysesthesias progressed to numbness in the feet bilaterally and spread to other areas of the body, including the face, throat, torso, and perineal area. Muscle weakness developed, leading to difficulty walking, swallowing, speaking, urinating, and maintaining erections.

Setting: Inpatient acute care hospital.

Assessment/Results: Initial examination revealed proximal muscle weakness, sensory changes, and saddle anesthesia with preserved reflexes. Imaging studies showed enhancement along bilateral facial nerves and a lumbar puncture was completed with albuminocytologic dissociation. Findings suggestive of Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP). The patient was started on IVIG, and there was an improvement in symptoms after the first dose.

The patient presented a month later with worsening weakness, diplopia, difficulty swallowing, and urinary retention. Imaging studies were stable. The patient was admitted to the ICU and plasma exchange (PLEX) was initiated. There was improvement in swallow, bowel and bladder continence, vision, and strength. After completion of PLEX the patient continued to have numbness in distal extremities and the lower portion of the face.

Discussion (relevance): Overall, understanding AIDP is important for clinicians and researchers alike, as it can aid in early diagnosis, prompt treatment, and potentially lead to new insights and treatments for other autoimmune and neuroinflammatory diseases.

Conclusions: In summary, this case describes a patient with progressive sensory disturbances and muscle weakness, ultimately leading to difficulty with ambulation, swallowing, and other bodily functions. Diagnostic studies were suggestive of AIDP, and the patient was treated with IVIG and PLEX leading to some improvement despite residual weakness and sensory symptoms.