Combined Central and Peripheral Demyelination with a Favorable Outcome: A Case with 10-Year Follow-up

Combined central and peripheral demyelination (CCPD) is a rare and heterogeneous condition, often associated with a poor prognosis. Contrary to the popular reports, we present a case of CCPD with a favorable prognosis and a 10-year follow-up.

A 29-year-old female patient presented with progressive limb weakness following a Brucella infection. She was subsequently diagnosed with motor type chronic inflammatory demyelinating polyneuropathy (CIDP), which was characterized by motor conduction blocks and demyelinating motor conduction abnormalities in a nerve conduction study (NCS). In the following years, the patient was diagnosed with CCPD with relapse and remissions, with or without CIDP attacks and multiple cranial neuropathy, cervical myelitis, and optic neuritis attacks. Despite exhibiting motor CIDP, she did not respond to intravenous immunoglobulin (IVIg) therapy, and all her episodes were removed with intravenous methylprednisolone (IVMP).

Our case has been in remission with azathioprine therapy for the last three years and is notable for its prolonged course, good prognosis, and potential association with Brucella infection.