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Clinical Reasoning: A 68-Year-Old Man With Palmar Rash, Leg Pain, and Inability to Walk
Joseph YoungHun Yoon1, Jacqueline Madeleine Solomon2, Yijia Li2
1From the Department of Neurology (J.Y.H.Y., J.M.S.), Massachusetts General Hospital, and Department of Neurology (J.Y.H.Y., J.M.S., S.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Neurology (J.M.S.), Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; and Division of Infectious Disease (Y.L.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Dr. Yoon is currently at the Department of Neurosurgery, The Mount Sinai Hospital, New York, NY. jyoon@mgh.harvard.edu.
Abstract:
We report a 68-year-old man with palmar rash, leg pain, and inability to walk, whose neurologic examination localized to multiple roots, leading to the diagnosis of polyradiculopathy. Polyradiculopathy has both structural and nonstructural etiologies. Structural etiologies include spinal stenosis, tethered cord syndrome, tumors, and leptomeningeal metastasis. Nonstructural etiologies include inflammatory, infectious, metabolic, and other neoplastic processes. His palmar rash in conjunction with neurologic signs/symptoms raised the suspicion for an infectious etiology, and eventually, serology and lumbar puncture confirmed the final diagnosis. In this report, we will further discuss how we determined the localization of polyradiculopathy, its specific etiologies, management decisions, and a transient complication before he achieved a significant improvement at 6 months.
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