A 38 year old female presented with paresthesia of hands and feet followed by severe weakness of lower extremities over a period of 1-2 weeks, to the extent that she could not stand without assistance, and needed help from the family for most of her activities of daily living. Over the next month the paresthesia and weakness gradually improved without any treatment; at the time of the visit 6 weeks after the onset of symptoms, she had no sensory symptoms, had some subjective weakness in her legs but could walk without assistance. She was referred to our center as an EMG done in an outside center one month after the onset of symptoms had shown a demyelinating neuropathy.

General physical exams was normal except for presence of lymphadenopathy in the axillary and inguinal regions. Neurological exam showed normal mental status and normal cranial nerves. Strength was 5/5. Sensory Examination showed  diminished pinprick up to the ankles and fingertips and decreased vibration at the toes. Coordination, reflexes and gait were normal. What is the differential diagnosis? Click here

Lab workup: WBC: 3.2 K/ μL, Hb 13.2 g/dl, HCT 39.5%, platelet 198 K/ μLCSF: protein 122 mg/dl, glucose 69 mg/dl, WBC: 10/μL, RBC: 34/μL,  BMP,  CK , ESR, CRP, ANA, C3, C4, Anti-dsDNA, RFs, SSA, SSB, Anti-RNP, anti-Smith, anti-ganglioside panel, Anti-myelin associated glycoprotein, Hep C Ab, Hep B Surface Ag and Lyme were negative. ACE level was 80 (8-52 nl). Serum protein Electrophoresis showed Globulin 4.0 (normal 2.5 – 3.5 g/dL nl) including gamma globulin level of 2.15 g/dl (0.5 – 1.5 g/dL nl).  Click here for EMG and further workup.