We report a case of a patient who presented complaining of a 1-week history of progressive lower limb weakness and decreased sensation bilaterally suggestive of a peripheral neuropathy, with vague associated symptoms of fluctuating concentration. Clinically, we suspected a Guillain-Barré variant. However, her functioning continued to decline despite intravenous immunoglobulin therapy, and she had normal spinal imaging studies and CSF analysis. Of note, she had a subtotal oesophagectomy and proximal gastrectomy 20 months previously for oesophageal cancer. We found her to be deficient in vitamin D, vitamin E and copper. She was treated with nutritional supplementation of these vitamins and infusion of trace elements, resulting in a gradual improvement in lower limb power, sensation and coordination, as well as improved cognition and mentation. Monthly outpatient neurology follow-up shows continued improvement in symptoms and return towards baseline functioning with regular infusions of nutritional elements and monitoring of blood levels.
- gastrointestinal surgery
- vitamins and supplements
- peripheral nerve disease
- oesophageal cancer
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Contributors PR was involved in the clinical care of the patient in the form of follow up and review in outpatients. PR conceived and planned the case report and obtained informed consent from the patient for publication of this case report. PR reviewed the patient’s chart and collected the required data and compiled the relevant results. PR designed and drafted the manuscript. PR is the primary author and is accountable for ensuring the accuracy and integrity of all aspects of the manuscript. PR responded to the reviewers comments and edited the manuscript prior to the resubmission in order to address the queries raised by reviewers. PK was involved in the clinical care of the patient in the initial assessment and management of the patient’s care. PK was the consultant for the Neurology team that the patient was admitted under in hospital and coordinated investigation and treatment. PK was involved in the initial design of the report. PK reviewed the revised manuscript and proposed response to the reviewers questions. He then provided approval for the revised manuscript to be submitted to BMJ Case Reports.
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.
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