Chronic inflammatory demyelinating polyneuropathy associated with intestinal tuberculosis.
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an increasingly common but under-recognized neurological disorder. It is immune mediated, and usually has a relapsing and remitting course. However, the initial presentation may be rapid. It can be associated with significant morbidity and mortality, particularly if there is a delay in diagnosis and treatment. It has been associated with both infective and non-infective etiologies. We present a case of CIDP associated with ileocecal tuberculosis (TB), presenting with progressive motor weakness and significant weight loss. The patient's symptoms improved to some extent with intravenous immunoglobulin and steroid, but improved significantly after being started on anti-TB therapy. However, his symptoms relapsed when he stopped his anti-TB treatment prematurely whilst continuing the immunosuppressive therapy. Upon resuming the anti-TB therapy, he made a good recovery. CIDP associated with TB has only been reported once. Our case highlights the need to consider TB in patients with neurological disorders.
Chong
Vui Heng
VH
Gastroenterology Unit, Department of Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei Darussalam. chongvuih@yahoo.co.uk
Joseph
Thykkoottathyl Pappy
TP
Telisinghe
Pemasiri Upali
PU
Jalihal
Anand
A
D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000150:complications* / Q000188:drug therapy; D014385:Tuberculosis, Gastrointestinal / Q000150:complications* / Q000188:drug therapy
D000995:Antitubercular Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents