51-year old man with tingling, burning and progressive limb weakness

Peripheral neuropathy is a common reason for referral to neurology. Chronic acquired demyelinating neuropathies are an important and varied group with overlapping presentations, and may have an immune-mediated cause. Their correct diagnosis is important as they respond to different treatments; timely intervention can prevent irreversible axonal degeneration. We present a case that highlights the approach to an adult presenting with a chronic demyelinating neuropathy.

[1]  M. Reilly,et al.  POEMS neuropathy: optimising diagnosis and management , 2018, Practical Neurology.

[2]  S. W. Rizvi,et al.  Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): An Uncommon Manifestation of Systemic Lupus Erythematosus (SLE) , 2017, The American journal of case reports.

[3]  A. Dispenzieri.  POEMS syndrome: 2017 Update on diagnosis, risk stratification, and management , 2017, American journal of hematology.

[4]  J. Mandrekar,et al.  Clinical spectrum of Castleman disease–associated neuropathy , 2016, Neurology.

[5]  E. Jaffe,et al.  Multicentric Castleman disease: Where are we now? , 2016, Seminars in diagnostic pathology.

[6]  R. Layzer,et al.  Sarcoid polyneuropathy masquerading as chronic inflammatory demyelinating polyneuropathy , 2015, Muscle & nerve.

[7]  G. Parry,et al.  Acquired Immunologic Neuropathies , 2015, Seminars in Neurology.

[8]  E. Anagnostou,et al.  Chronic inflammatory demyelinating polyneuropathy associated with neurosyphilis. , 2015, The American journal of the medical sciences.

[9]  G. Sobue,et al.  Clinicopathological features of neuropathy associated with lymphoma. , 2013, Brain : a journal of neurology.

[10]  W. Louthrenoo,et al.  Sensitivity and specificity of ANA and anti-dsDNA in the diagnosis of systemic lupus erythematosus: a comparison using control sera obtained from healthy individuals and patients with multiple medical problems. , 2013, Asian Pacific journal of allergy and immunology.

[11]  R. Lewis,et al.  Evaluation of a patient with suspected chronic demyelinating polyneuropathy. , 2013, Handbook of clinical neurology.

[12]  D. Weisenburger,et al.  The clinical spectrum of Castleman's disease , 2012, American journal of hematology.

[13]  J. Mandrekar,et al.  Uniform demyelination and more severe axonal loss distinguish POEMS syndrome from CIDP , 2012, Journal of Neurology, Neurosurgery & Psychiatry.

[14]  A. Dispenzieri,et al.  Bone marrow histopathology in POEMS syndrome: a distinctive combination of plasma cell, lymphoid, and myeloid findings in 87 patients. , 2011, Blood.

[15]  C. Sommer,et al.  Chronic inflammatory demyelinating polyradiculoneuropathy: diagnostic and therapeutic challenges for a treatable condition , 2010, The Lancet Neurology.

[16]  Morel Ayala Zoilo,et al.  Chronic inflammatory demyelinating polyradiculoneuropathy in a boy with systemic lupus erythematosus , 2010, Rheumatology International.

[17]  H. Watanabe,et al.  Neuropathic pain correlates with myelinated fibre loss and cytokine profile in POEMS syndrome , 2008, Journal of Neurology, Neurosurgery, and Psychiatry.

[18]  F. Ducray,et al.  [Chronic inflammatory demyelinating polyneuropathy and sarcoidosis: fortuitous association?]. , 2007, Revue neurologique.

[19]  V. Chong,et al.  Chronic inflammatory demyelinating polyneuropathy associated with intestinal tuberculosis. , 2007, Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi.

[20]  M. Weisman,et al.  Chronic inflammatory demyelinating polyneuropathy in patients with systemic lupus erythematosus: prognosis and outcome. , 2005, Seminars in arthritis and rheumatism.

[21]  D. Karcher,et al.  Lymphoma and peripheral neuropathy: A clinical review , 2005, Muscle & nerve.

[22]  Y. Kasamon,et al.  EBV‐associated lymphoma and chronic inflammatory demyelinating polyneuropathy in an adult without overt immunodeficiency , 2002, American journal of hematology.

[23]  A. Verma.  Epidemiology and clinical features of HIV‐1 associated neuropathies , 2001, Journal of the peripheral nervous system : JPNS.

[24]  A. Avilés,et al.  Serum beta 2 microglobulin in solitary plasmocytomata [letter; comment] [see comments] , 1990 .

[25]  A. Avilés,et al.  Serum beta 2 microglobulin in solitary plasmocytomata. , 1990, Blood.

[26]  D. Resnick,et al.  Plasma Cell Dyscrasia with Polyneuropathy, Organomegaly, Endocrinopathy, M Protein, and Skin Changes: The POEMS Syndrome REPORT ON TWO CASES AND A REVIEW OF THE LITERATURE , 1980, Medicine.

[27]  C. Janeway,et al.  The gamma globulins and their clinical significance. III. Hypergammaglobulinemia. , 1959, The New England journal of medicine.

[28]  C. Janeway,et al.  The gamma globulins and their clinical significance. I. Chemistry, immunology and metabolism. , 1959, The New England journal of medicine.

[29]  R. Crow.  Peripheral Neuritis in Myelomatosis , 1956, British medical journal.