Zachary Dickey, BS
OMSIV
Edward Via College of Osteopathic Medicine - Louisiana Campus
Ruston, Louisiana, United States
David Nguyen, DO
PGY3
UNM Department of Orthopedics
Albuequerque, New Mexico, United States
Wallace Gladden, MD
Physiatrist
Lovelace UNM Rehabilitation Hospital
Albuequerque, New Mexico, United States
Acute Inflammatory Demyelinating Polyneuropathy (AIDP) vs Chronic Inflammatory Demyelinating Polyneuropathy (CIDP).
Case Description:
A 21-year-old G1P0 female presented in her second trimester with bilateral facial paralysis. In subsequent days to weeks the patient developed descending progressive weakness and urinary incontinence. A lumbar puncture was performed and albumincytologic dissociation was observed. Electrodiagnostic studies were further suggestive of AIDP.
The patient underwent plasmapheresis seven times over the following weeks with minimal improvement before relapsing. Following relapse plasmapheresis was completed an additional three more times before IVIG treatment was initiated. While undergoing treatment with IVIG the patient developed an acute pulmonary embolism associated with HELLP syndrome.
Following emergent caesarean section and stabilization, the patient was discharged to inpatient rehab (IR) but again relapsed resulting in subsequent respiratory distress. Upon recovery the patient was readmitted to IR where she began weekly plasmapheresis. The patient made significant recovery during her second IR course but had persistent motor deficits upon discharge.
Discussions:
Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are the most common acquired immune mediated polyneuropathies. Acquired demyelinating neuropathies most commonly present associated with antecedent illness, vaccination, or surgery. Pregnancy has been associated with CIDP exacerbations and relapse, however, the initial presentation of AIDP or CIDP during pregnancy is poorly understood and not well reported in literature.
Conclusions:
We present a complex case of an atypical pregnancy induced AIDP vs CIDP. This case highlights the need for improved differentiation between AIDP vs CIDP in atypical presentations. It underscores pregnancy as a risk factor for development of demyelinating pathology and explores a potential relationship between IVIG use in pregnancy and development of HELLP syndrome.
