Clinical case of severe axonal polyneuropathy of unknown etiology

The article presents a clinical case of acute motor-sensory axonal polyneuropathy of unknown etiology in a 57-year-old man. The disease manifested acutely with fever and skin rashes, followed by rapid development of muscle weakness, sensory disturbances, and areflexia, which required hospitalization. Differential diagnosis ruled out common causes: Guillain-Barré syndrome, paraneoplastic, rheumatological, toxic, and hereditary polyneuropathies. It can be assumed that the polyneuropathy is immune-mediated due to an acute respiratory infection suffered 4 weeks before the onset of the disease. Electroneuromyographic examination confirmed severe axonal damage to the peripheral nerves with secondary demyelination. The polyneuropathy was complicated by deep vein thrombosis of the lower extremities, the delayed diagnosis of which slowed recovery. Despite symptomatic therapy, including anticoagulants and neurometabolic agents, only partial improvement was achieved during 1.5 years of observation: muscle mass and strength were restored, but neuropathic pain, paresthesia, and areflexia persisted. Complete recovery is considered unlikely. This case illustrates the diagnostic difficulties in idiopathic polyneuropathies and the importance of early detection and treatment of complications to improve prognosis.