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Washington University Experience | PERIPHERAL NEUROPATHY | 9A SARCOID | 5A0 Case 5 History
Case 5 History ---- A 65-year-old woman experienced nausea and abdominal pain for 3 months without explanation preceding neurological presentation. She subsequently developed symmetrical paresthesias which progressed over 2–3 weeks to culminate in moderate bilateral leg weakness and mild distal leg sensory loss for all modalities. Reflexes were diminished and ankle jerks absent. Nerve conduction studies demonstrated symmetrical axonal polyneuropathy. CSF examination was normal. She had an ESR of 39 (Westergren) and ANA of 1:320. Renal, liver, and thyroid indices were normal. CBC, immunoelectrophoresis, serum calcium, serum ACE, porphyria screen, chest X-ray, pulmonary function tests, and abdominal ultrasound were normal. Nerve biopsy was performed 2 months after the onset of symptoms. Following nerve biopsy, prednisone was initiated but was not tolerated by the patient. The severity of the patient’s illness remained unchanged. Prednisone was initiated again 6 months after onset, and over the subsequent year, there was gradual improvement with complete resolution of weakness and most sensory signs. Painful paresthesias became the major management issue. Several months since the cessation of steroid therapy, there was no worsening. (Bilbao & Schmidt, 2015)
