Abstract Details

Title Acute-Onset Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) in a well-controlled diabetic patient without complications

Topic General Neurology

Presentation(s) General Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 058

Objective NA

Background This is a report on a rare case of acute-onset chronic inflammatory demyelinating polyneuropathy (CIDP) developing in a well-controlled diabetic patient who had no complications (including diabetic neuropathy).

Design/Methods 61-year-old male found unresponsive was admitted to the hospital and diagnosed with diabetic ketoacidosis (Type II DM). He was stabilized and discharged with mild paresthesia from which he recovered post-hospitalization. At his first neurologic outpatient visit, he complained of increasing mild numbness and paresthesia in both feet over the prior month and was unresponsive to gabapentin. He had significant weight loss and was unable to ambulate without assistance. He had weakness in his left hand and could not extend the 4th and 5th digits and showed decreased motor activity in both lower extremities (hip: 3/5 thigh: 3-/5; leg: 3/5) with decreased sensation in the distal regions. His labs and HbA1c (6.3) were normal. His electromyograph showed acute severe distal axonal polyneuropathy without evidence of demyelination or motor neuron disease. LP showed significant elevated protein without pleocytosis (244 mg/dL) and brain CT was normal. His differential was GBS or AIDP. The patient was given IVIg 1g/kg/day for 2 days and received physical, occupational, and speech therapy. He showed improvement for the next 3 months. Then he relapsed and his neurological exam showed worsening weakness which confirmed a diagnosis of CIDP. He was again treated with IVIg 1g/kg/day for 2 days. A month later, he showed some improvement and was started on azathioprine (50 mg/day up-titrated to 150 mg/day). He continues to get better and 5 months later, he showed significant motor function improvement (hip: 5/5 thigh: 5/5; leg: 3/5). One year later, he is walking independently.

Results NA

Conclusions Acute-onset CIDP should be considered as a differential in well-controlled diabetic patients presenting with paresthesia and significant limb weakness and no diabetic complications (including neuropathy).

Authors/Disclosures
Gaurav Kiri PRESENTER	Gaurav Kiri has nothing to disclose.
Liliana Montoya, MD (Neurology PA)	Dr. Montoya has nothing to disclose.

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