Abstract
A 58-year-old man presented with numbness and muscle twitching in the lower limbs since 2.5 months and muscle twitching in the upper limbs since 2 days. In early April 2015, the patient noticed numbness and coolness in the toes of both his feet without any obvious cause, and occasional muscle twitching in the left calf. He developed pain in both calves and twitching in the left thigh; and the muscle twitching gradually worsened in May. On June 9, he experienced muscle twitching in the upper extremities. He had a normal diet with increased sweating, chills, poor sleep, and a weight loss of 15 kg in 2 months.
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