The goal of this case series is to illustrate the clinical presentation and treatment in 2 patients with novel antibodies to TS-HDS and FGFR-3.

Two pediatric patients with acquired neuropathy were identified to have antibodies against TS-HDS or FGFR-3. Each chart was reviewed for presentation, diagnosis, intervention, and outcome.

Case 1: 15-year-old female with juvenile myoclonic epilepsy presented with back pain, bilateral hand and leg paresthesia, and shuffling gait. Exam notable for diminished sensation in the extremities, absent lower extremity reflexes, and sensory ataxia. Testing was positive for IgM against TS-HDS antibodies (31,000; normal is < 12,000).

Case 2: 12-year-old male with ADHD presented with worsening leg pain, bilateral foot paresthesia, and hand twitching. Exam notable for intact strength, sensation, reflexes, and gait. Testing was positive for IgG against FGFR-3 antibodies (4,600; normal is < 3,000).

Both patients were found to have axonal neuropathy on EMG. Treatment was initiated with monthly intravenous immunoglobulin (IVIG). There is subjective and objective improvement in one patient with monthly IVIG treatment.

There is limited data for treatment of immune-mediated neuropathy in pediatric patients. Further investigation is needed to determine the role of these antibodies in pediatric cases and whether IVIG will be beneficial.