(Kiosk 1) Rare Case: Young Female with Acute Generalized Weakness Secondary to Acute Alcoholic Peripheral Neuropathy: A Case Report

Case Diagnosis: Acute generalized weakness secondary to acute alcoholic peripheral neuropathy

Case Description or Program Description: 33 y.o. Female with past medical history remarkable for a history of alcohol abuse (drinks four beers daily with 8% ABV) for more than six years, depression, gastric sleeve operation in 2013, mild peripheral neuropathy on hands and feet since one year not on any medication, who presented with acute generalized weakness significant on lower extremities associated with numbness and tingling. Patient also reported persistent cough and diarrhea for the last month. The physical exam was remarkable for severe bilateral proximal and distal weakness in bilateral upper and lower extremities. Sensory impairment was noted on bilateral upper and lower extremities to the light touch and pinprick proprioception. Reflexes were absent. There were no upper motor neuron signs and respiratory or bulbar symptoms. Pertinent positive labs include a drug screen positive for meth and cocaine, sed 120. Lumbar puncture, MRI of the head, and whole spine were unremarkable. Patient was treated with IVIG for five days, high-dose thiamine, and high-dose solumedrol for three days with no improvement. Sural nerve biopsy showed “rare axonal degeneration and Schwann cell processes surrounding connective tissue, affects both myelinated and unmyelinated axons.”

Setting: Tertiary care trauma center

Assessment/Results: Patient was diagnosed with acute alcoholic peripheral neuropathy and admitted to inpatient rehabilitation (IPR). During IPR stay, limited EMG was performed, which showed severe sensorimotor mixed (axonal and demyelinating) neuropathy. Patient had severe pain and refused participation during therapies and was discharged home at wheelchair level with 24/7 hours help.

Discussion (relevance): This case suggests that this could be a potential differential diagnosis to consider in patients with acutely presenting polyneuropathies resembling GBS but do not respond to immunotherapy.

Conclusions: Alcoholic neuropathy is characterized by a symmetric polyneuropathy pattern with greater involvement of the lower extremities. It can progress rapidly and may be mistaken for Guillain-Barre Syndrome (GBS).