Waiting for the Other Foot to Drop

A CLINICAL PROBLEM-SOLVING article by Eileen Scully from Brigham and Women's Hospital, Boston.
A 65-year-old man presented with fevers and progressive weakness. He had been well until 4 months previously, when daily fevers, sweats, fatigue, impaired concentration, and weakness developed. He also reported that pain in his feet and calves.
On physical examination, strength was normal in the proximal arms but was decreased in both wrists, the fingers, the right hip, the right foot, and the great toes bilaterally. Ambulation without supportive bracing revealed a profound foot drop on the right side (a finding that is shown in the video at NEJM.org).
The patient had undergone coronary-artery bypass grafting 15 months earlier, which had been complicated by a hernia in the upper abdominal wall that was repaired with surgical mesh. The patient's medical history also included hepatitis B virus (HBV) infection, gout, hyperlipidemia, hypertension, gastroesophageal reflux, and hypothyroidism.
Ongoing fevers in a previously well patient may be caused by infection, a malignant condition, autoimmune or inflammatory disease, or medications.
Two components of the medical history that warrant attention are the hypothyroidism which may be associated with neuropathy and the HBV infection which is associated with a painful vasculitic neuropathy. (206 words/ 99sec = 125 wpm)

慢性炎症性脱髄性多発神経炎(CIDP)です。日本神経学会のHPでは、まだガイドラインの公開はないようです。