Abstract
A 48-year-old man presented with sensory disturbances in both hands and feet and difficulties when opening bottles or climbing the stairs. His symptoms had developed over 2 weeks and were preceded by fever of unknown origin. There was no history of toxin exposure. His past medical history was remarkable for Henoch-Schonlein purpura with nephritis and intestinal necrosis. Examination showed weakness of the neck, arm, and proximal leg muscles (Medical Research Council [MRC] grade 4). Vibration sense was diminished in both hands and feet, without a sensory level. Tendon reflexes were absent. There were no gastrointestinal symptoms, purpurae, or evidence of glomerulonephritis. Nerve conduction studies showed that the distal motor latency (DML) was increased in the median (5.6 milliseconds), ulnar (5.4 milliseconds), and peroneal nerves (19.2 milliseconds) and that the nerve conduction velocity (NCV) was decreased in the median (32 m/s) and peroneal (15.5 milliseconds) nerves, with conduction block and sural sparing.1 The CSF was normal. Screening for syphilis was negative. The patient was diagnosed with Guillain-Barre syndrome (GBS) and was treated with IV gammaglobulin …
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