Small-fibre polyneuropathy caused by chemical agent resistant coating

Abstract

We describe a 65-year-old man who during his service in the military developed an acute onset of burning pain in his feet and hands shortly after an acute, severe exposure to the fumes of chemical agent resistant coating (CARC). This chemical is used in the military to paint vehicles and equipment to create metal surfaces resistant to corrosion and penetration by chemical agents. Extensive laboratory workup for peripheral neuropathies was unremarkable. Nerve conduction studies showed axonal-loss polyneuropathy. Skin biopsy confirmed a small-fibre polyneuropathy (SFP). His burning pain persisted over three decades and was partially controlled with tramadol. This is the first case of SFP caused by acute CARC exposure with long-term surveillance.

Keywords: neurological injury; neurology; peripheral nerve disease.

Figure 1

(A) Right calf skin biopsy and (B) right thigh skin biopsy showing significant reduction in epidermal nerve fibre density. The loss of nerve fibres correlates well with the distribution of the patient’s clinical sensory impairment and is consistently reduced throughout all sampled sites.