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Small-fibre polyneuropathy caused by chemical agent resistant coating
  1. Brandon Marshall1,
  2. Umesh Sharma MD1,2,
  3. Nina Tsakadze MD1,2 and
  4. Fabian H Rossi MD1,2
  1. 1University of Central Florida College of Medicine, Orlando, Florida, USA
  2. 2Department of Neurology, Orlando Veterans Affairs Medical Center - Lake Nona, Orlando, Florida, USA
  1. Correspondence to Brandon Marshall; brmarshall{at}


We describe a 65-year-old man who during his service in the military developed an acute onset of burning pain in his feet and hands shortly after an acute, severe exposure to the fumes of chemical agent resistant coating (CARC). This chemical is used in the military to paint vehicles and equipment to create metal surfaces resistant to corrosion and penetration by chemical agents. Extensive laboratory workup for peripheral neuropathies was unremarkable. Nerve conduction studies showed axonal-loss polyneuropathy. Skin biopsy confirmed a small-fibre polyneuropathy (SFP). His burning pain persisted over three decades and was partially controlled with tramadol. This is the first case of SFP caused by acute CARC exposure with long-term surveillance.

  • neurology
  • neurological injury
  • peripheral nerve disease

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  • Contributors Manuscript development: BM, US, NT and FHR. Manuscript Review: BM, US, NT and FHR.

  • 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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