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

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

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.

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