A RARE CASE OF MIXED CHRONIC INFLAMMATORY DEMYELINATING POLYRADICULOPATHY (CIDP) AND ACUTE TRANSVERSE MYELITIS (ATM).

Abstract

Introduction/background: Though CIDP and ATM are both inflammatory disorders of the nervous system with distinct features, they rarely occur together in the same individual.

Case presentation: A 41-year-old male trader was admitted with 10 10-day history of paraplegia and weakness of upper limbs. The illness started with lower limb paresthesia, weakness of the left leg, then the right leg after 5 days, proceeding to paraplegia, weakness of upper arms, urine retention, and constipation 3 days before presentation. There was a brief fever; no sore throat or cough; no travel outside the country; and no vaccination. He smoked 10 cigarette packs yearly and drank alcohol occasionally. He was unmarried. Vital signs were stable with normal mentation; oxygen saturation 98%; no cranial nerve deficits; flaccid paraplegia; flaccid bilateral upper limbs weakness (MRC 1/5) and symmetrical sensory loss to the level of T4. HIV, hepatitis B, and C antibodies were all negative; hematological, renal, and liver functions were normal. CSF cyto-albumin dissociation and hyperintensities of the cervical and upper thoracic spinal cord on MRI necessitated a diagnosis of mixed CIDP and ATM. Although the patient could not buy IV immunoglobulin, he has been on prednisolone; and 40 days later flaccid paraplegia and sensory loss persist, but tone and reflexes have returned to normal, and power is MRC 3/5. He remains conscious, is dyspnoeic, and is currently on a mechanical ventilator with a feeding nasogastric tube and urinary catheter in situ.

Conclusion: Both CIDP and ATM are distinct severe neuro-inflammatory diseases requiring emergency and intensive care management as each has potential for high mortality outcomes.