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Very-Early-Onset Treatment-Refractory Pediatric Chronic Inflammatory Demyelinating Polyradiculoneuropathy Responsive

Hoda Y Tomoum1, Dalia M El-Mikkawy2, Rasha H El-Owaidy3

  • 1Pediatric Neurology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.

Journal of Child Neurology
|December 16, 2025
PubMed

Insights

Treatment-refractory very-early-onset chronic inflammatory demyelinating polyradiculoneuropathy in a young child responded well to a combination of pulsed methylprednisolone, plasma exchange, and rituximab therapy. This regimen offers a potential new approach for challenging pediatric cases.

Area of Science:

  • Pediatric Neurology
  • Immunology

Background:

  • Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a treatable pediatric polyneuropathy.
  • Treatment strategies for refractory very-early-onset CIDP (symptoms before age 4) are not well-defined.

Purpose of the Study:

  • To report a successful treatment approach for a case of treatment-refractory, very-early-onset CIDP in a young child.

Main Methods:

  • The patient, aged 30 months, initially received intravenous immunoglobulin and corticosteroid monotherapy without response.
  • Treatment was switched to combined pulsed intravenous methylprednisolone and plasma exchange.
  • Followed by induction and maintenance therapy with rituximab.

Main Results:

  • The child showed a significant and sustained clinical improvement after the combined therapy.
  • This regimen demonstrated efficacy in a treatment-refractory pediatric case.

Conclusions:

  • Combined pulsed methylprednisolone, plasma exchange, and rituximab can be an effective treatment for refractory very-early-onset CIDP in children.
  • This case highlights a potential therapeutic option for severe pediatric neuropathies.

Keywords:
pediatric CIDPplasma exchangerituximabtreatment refractory CIDPvery-early-onset CIDP

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