Diabetic Neuropathy |JULY 5, 2020
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Remission of chronic inflammatory demyelinating polyneuropathy following adenotonsillectomy.
Harsha WJ, Goco PE, Crawford JV.
Department of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA 98431-5000, USA.
Patients with chronic inflammatory demyelinating polyneuropathy (CIDP) experience proximal- and distalextremity weakness, sensory loss, and often hyporeflexia or areflexia. CIDP is associated with a variety of concomitant medical illnesses, which often manifest weeks before the onset of muscle weakness and paresis. We describe what we believe is the first reported case of an association between CIDP and recurrent acute adenotonsillitis, which we observed in an 11-year-old girl. Following adenotonsillectomy, the patient's CIDP went into remission and her overall physical condition improved with physiotherapy.
An 11-year-old girl with CIDP was brought to us for evaluation. At the age of 4 years, she developed a generalized paralysis that necessitated hospital admission and prolonged ventilatory support. At that time, she was initially diagnosed with Guillain-Barre syndrome. However, following a prolonged recovery from this initial acute event and after frequent and intermittent relapses of weakness and paresis, the diagnosis of CIDP was established.
The patient later experienced two relapses, and she was treated with IV Ig. Treatment had increased the speed with which her weakness resolved, but she continued to experience relapses. Her episodes of weakness and paresis were generally preceded by fever or illness. Her most common systemic illness was recurrent acute adenotonsillitis, which had occurred approximately four times a year. Each episode of adenotonsillitis was followed in 2 to 6 weeks by increased weakness, primarily in her lower extremities, that necessitated the use of a wheelchair.
On physical examination, the patient had slightly enlarged tonsils for her age and adenoids that were 30% obstructive of the choanae. A standard adenotonsillectomy was performed. At the 1-year postoperative follow-up, both the patient and her family reported no episodes of sore throat or upper respiratory illness, no further relapses of acute paralysis, and an improvement in her baseline strength and agility with physiotherapy