A RARE CASE OF CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY WITH CONCURRENT ABDOMINAL TUBERCULOSIS

Abstract

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a rare, immune-mediated neuropathy characterized by progressive or relapsing motor and sensory dysfunction due to peripheral nerve demyelination. CIDP can be associated with autoimmune conditions, infections, or vaccines. The coexistence of CIDP with abdominal tuberculosis (TB) is extremely uncommon and poses a diagnostic challenge due to overlapping symptoms with more common diseases and neuropathies. We report the case of a 17-year-old female with a history of abdominal TB who presented with progressive bilateral lower limb weakness and difficulty walking for one month. Neurological evaluation revealed decreased muscle strength in both upper and lower limbs, diminished deep tendon reflexes, but preserved superficial and cortical sensations. Nerve conduction studies and MRI supported the diagnosis of CIDP. Differential diagnoses including diabetic neuropathy, Guillain-Barré Syndrome, paraneoplastic neuropathy, and hereditary motor-sensory neuropathies were considered and excluded based on clinical findings, laboratory results, and imaging. Cerebrospinal fluid analysis revealed elevated protein without pleocytosis, further supporting CIDP. The patient was treated with intravenous methylprednisolone and immunoglobulin therapy, resulting in clinical improvement. This case emphasizes the importance of recognizing CIDP in patients with atypical presentations, especially when coexisting with infections like abdominal TB. Misdiagnosis can lead to delayed or inappropriate treatment, worsening outcomes. A comprehensive diagnostic approach including clinical examination, electrophysiological studies, CSF analysis, and imaging is essential to distinguish CIDP from other demyelinating neuropathies. Early recognition and timely initiation of immunomodulatory treatment are crucial to prevent complications and improve prognosis. Our report adds to the limited literature on CIDP with abdominal TB and also highlights the need for increased clinical awareness of this rare but treatable neurological condition.