415 - Atypical Concomitant Autoimmune Disorders in Antibody Negative CIDP: A Case Report

CIDP: antibody-negative

A 32-year-old male presented with five days of diffuse paresthesias. Initial workup included LP revealing albuminocytologic dissociation and EMG indicating absent H-reflexes, prolonged F-wave and distal sensory latencies. The patient was started on IVIG treatment for suspected GBS. Shortly after, his condition further deteriorated, leading to dysautonomic respiratory complications requiring intubation. The patient was started on PLEX and IV steroids. He was extubated and transferred to an IRF. During the rehab course, the patient experienced a severe drop in platelets to 4000, concerning for immune thrombocytopenia. The concomitant ITP required transfer out to a higher level of care for stabilization. He received platelet transfusions and another round of IVIG with steroids. The patient returned to rehab and was eventually discharged home. However, he experienced relapsing symptoms shortly after, with proximal/distal motor weakness and decreased proprioception. The recurrent nature alluded to a diagnosis of CIDP, with negative CNTN1 and NF155 antibodies.

This case highlights the diagnostic challenge and therapeutic management of a patient with relapsing and atypical presentation of CIDP. Repeat inpatient EMG was consistent with demyelinating polyneuropathy with secondary axonal loss, suggestive of CIDP. The patient showed improvement following repeat treatments and multiple courses of rehabilitation, achieving full strength and temporary resolution of sensory impairment with neuropathy. Despite the patient's improvement with treatment and rehabilitation, the resurgence of his CIDP symptoms suggests his journey to recovery remains uncertain, highlighting the need for further research in managing such complex and recurrent forms of CIDP.

The authors’ case emphasizes the importance of continuous monitoring and flexible treatment strategies in managing complex atypical cases of CIDP. It illustrates the necessity for multidisciplinary care, with vigilant monitoring for rare complications such as immune thrombocytopenia, and comprehensive rehabilitation to achieve optimal patient outcomes and function.