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Description

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated neuropathy with a wide range of clinical presentations. Early disease may resemble other acquired neuropathies, leading to diagnostic uncertainty. We describe a case of relapsing, treatment-refractory CIDP that initially presented as a painful lumbosacral syndrome and later demonstrated sustained clinical improvement with B-cell-directed therapy.

A 69-year-old man with a history of type 2 diabetes mellitus presented with severe unilateral lumbosacral and buttock pain followed by progressive proximal leg weakness and weight loss, without clear sensory deficits or muscle atrophy. MRI of the brain and lumbar spine revealed no acute abnormalities, cauda equina pathology, or structural etiology to explain his symptoms, aside from stable multilevel degenerative changes. Electrodiagnostic testing showed a predominantly axonal polyradiculoneuropathy with limited demyelinating features. Cerebrospinal fluid (CSF) analysis was unremarkable. The patient was given a presumptive diagnosis of diabetic lumbosacral radiculoplexus neuropathy and treated with conservative management and rehabilitation. He later developed progressive neck and shoulder pain with radiation into the upper extremities, followed by distal sensory symptoms, gait instability, generalized weakness, and areflexia. Repeat electrodiagnostic studies demonstrated a diffuse acq

This case highlights the evolving presentation of CIDP and underscores the importance of maintaining a high index of suspicion and continually reassessing initial diagnostic labels in relapsing neuropathies. While first-line therapies for CIDP include high-dose corticosteroids, intravenous immunoglobulin, and plasma exchange, rituximab may serve as an effective treatment option in severe, treatment-resistant cases.

Publication Date

5-8-2026

Disciplines

Neurology

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2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2021

Beyond IVIG: Diagnostic Reclassification and Rituximab Response in Relapsing CIDP

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