Chronic inflammatory demyelinating polyradiculoneuropathy and hyponatremia in a patient with chronic graft versus host disease

Abstract

A 54-year-old woman, who was treated with chemotherapy for acute lymphoblastic leukemia, developed dysesthesia in her hands and feet at the age of 50 in 2003. The following year she underwent hematopoietic stem cell transplantation. In 2005, she was diagnosed with chronic graft versus host disease (cGVHD). In December 2006, she developed dysesthesia in her face and tongue (onset). 50 days after the onset, she had a respiratory infection. 10 days later, she was hospitalized for muscle weakness of four extremities and progression of dysesthesia. Nerve conduction studies and superficial peroneal nerve biopsy revealed demyelination. After high-dose immunoglobulin therapy, her muscle strength recovered. Hyponatremia was resolved by restriction of fluid intake and administration of NaCl. We suggest immunological mechanisms such as cGVHD may cause chronic inflammatory demyelinating polyradiculoneuropathy and hyponatremia.