Immune globulin
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Deterioration of chronic inflammatory demyelinating polyneuropathy in a diabetic patient: case report A 54-year-old woman with type 2 diabetes mellitus experienced deterioration of chronic inflammatory demyelinating polyneuropathy (CIDP) during treatment with immune globulin. The woman, who was diagnosed with CIDP in June 2002, received a course of IV immune globulin 0.4 g/kg/day over 5 days. She had a moderate positive response for 3 days after which she rapidly deteriorated and became wheelchair bound [time to reaction onset not stated], despite receiving a second course of immune globulin [dosage and duration of treatment not stated] administered 15 days after the first course. On admission in October 2002, neurological examination showed tetraparesis, diminished perception of pain, vibration, touch and position sense and generalised areflexia; she also had absent Babinski signs. Laboratory investigations revealed a glycosylated haemoglobin level of 5.5% and an erythrocyte sedimentation rate of 36 mm/h. Electrophysiological examination showed severely decreased conduction velocities, conduction blocks and absent F waves. Electromyelography in her left first dorsal interosseous and right tibialis anterior muscle showed polyphasic motor unit potentials and fibrillations. Mild hyperproteinorachia (62 mg/dL) and 3 cells/mm3 were revealed by CSF analysis. The woman started receiving methylprednisolone and, 1 month later, she was able to walk alone and her strength had improved. She received azathioprine and, in April 2003, she had normal sensations in her arms and could walk without assistance. Two years later, neurological examination only revealed weak right ankle jerk, right-interosseous weakness and diminished perception of vibration at her toes. Pedersen K, et al. Chronic inflammatory demyelinating polyneuropathy in a diabetic patient: deterioration after intravenous immunoglobulins treatment and favorable response to steroid treatment. Acta Neurologica Belgica 107: 14-17, No. 801090700 1, Mar 2007 - Belgium
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Reactions 4 Aug 2007 No. 1163
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