A 56-year-old woman presented with 3 months history of all four limbs’ numbness in glove and stocking distribution. A week before admission, she developed all four limbs’ weakness and numbness. Brain and whole spine imaging revealed no lesions, and cerebrospinal fluid showed high protein. A nerve conduction study revealed severe sensorimotor polyneuropathy, and she was diagnosed with chronic inflammatory demyelinating polyneuropathy. We treated her with plasma exchange and later developed bilateral pulmonary embolism, deep venous thrombosis and worsening of weakness. The second set of seven sessions of plasma exchange gave her improvement in muscle strength. However, after a chest infection, another neurological deterioration occurred. The third set of plasma exchanges resulted in excellent response. Nineteen months into her illness she developed a headache followed by left upper limb weakness and focal seizures with left side involvement. Brain imaging revealed a right frontal enhancing lesion that required resection, and biopsy showed diffuse large B-cell lymphoma. She was treated with chemotherapy and whole-brain radiation therapy and remained with left-sided weakness.
- neuromuscular disease
- peripheral nerve disease
- epilepsy and seizures
- haematology (incl blood transfusion)
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Contributors NIK has contributed with case report design, planning, scanned files review, writing patient history, investigations, treatment, follow up, interpretation of data, obtained patient consent, coordinated work with other coauthors and submission on behalf of all of them. EK has contributed with interpretation of data, literature review and discussion part. JAG has contributed with selecting good quality images from PACS as per the journal requirements and intellectual content of the manuscript. SA has contributed with interpretation of data, literature review and discussion part. MHA has contributed with intellectual content and supervision.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.