Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Mar 1;63(5):733-737.
doi: 10.2169/internalmedicine.2021-23. Epub 2023 Jul 19.

Repeated Acute Exacerbations of Chronic Inflammatory Demyelinating Polyradiculoneuropathy Accompanied by Pain and Swelling in Distal Extremities

Takenobu Murakami  1   2 , Masafumi Kishi  1   3 , Naoki Tokuda  1   2 , Makoto Honda  1 , Ritsuko Hanajima  2
Affiliations
Case Reports

Repeated Acute Exacerbations of Chronic Inflammatory Demyelinating Polyradiculoneuropathy Accompanied by Pain and Swelling in Distal Extremities

Takenobu Murakami et al. Intern Med. .

Abstract

An 81-year-old man experienced acute progression of weakness in the extremities accompanied by a fever, tenderness, and swelling in distal parts of the extremities. He had flaccid tetraparesis with fasciculations and general hyporeflexia. Nerve conduction studies indicated demyelinating sensorimotor neuropathy. A cerebrospinal fluid examination revealed elevated proteins without pleocytosis. Immunological treatments were effective, but his symptoms exhibited repeated relapse and remission phases. He was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with an acute onset. The highlight of this case is pain with inflammatory reaction recognized as red flags of CIDP, with the clinical course and electrophysiological findings compatible with CIDP.

Keywords: chronic inflammatory demyelinating polyradiculoneuropathy; fever; nerve conduction studies; pain; red flags.

PubMed Disclaimer

Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Swelling on the right hand. The patient also experienced tenderness in distal parts of the extremities.
Figure 2.
Figure 2.
Left median nerve conduction study findings before (A-C) and after (D-F) treatment. (A) Prolongations of motor distal latency and distal compound motor action potential duration, reduction of motor conduction velocity, and motor conduction block were evident. (B) An F-wave was not evoked. (C) Sensory distal latency prolongation and reductions in sensory nerve action potential and sensory conduction velocity were found. (D) Motor distal latency prolongation and conduction block were improved. (E) F-waves were observed, but the latency was prolonged after treatment. (F) Sensory distal latency prolongation and reduction of sensory nerve action potential were improved.
Figure 3.
Figure 3.
Left median nerve somatosensory evoked potential findings before (A) and after (B) treatment. (A) No components were evident before treatment. (B) Components appeared, but their latencies were prolonged in the peripheral nerve after treatment.
See this image and copyright information in PMC

References

    1. Dyck PJB, Tracy JA. History, diagnosis, and management of chronic inflammatory demyelinating polyradiculoneuropathy. Mayo Clin Proc 93: 777-793, 2018. - PubMed
    1. Van den Bergh PYK, van Doorn PA, Hadden RDM, et al. European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force - second revision. J Peripher Nerv Syst 26: 242-268, 2021. - PubMed
    1. Odaka M, Yuki N, Hirata K. Patients with chronic inflammatory demyelinating polyneuropathy initially diagnosed as Guillain-Barré syndrome. J Neurol 250: 913-916, 2003. - PubMed
    1. Mori K, Hattori N, Sugiura M, et al. Chronic inflammatory demyelinating polyneuropathy presenting with features of GBS. Neurology 58: 979-982, 2002. - PubMed
    1. Neligan A, Reilly MM, Lunn MP. CIDP: mimics and chameleons. Pract Neurol 14: 399-408, 2014. - PubMed

Publication types

MeSH terms