Reversible tetraplegia after percutaneous nephrostolithotomy and septic shock: a case of critical illness polyneuropathy and myopathy with acute onset and complete recovery

Abstract

BackgroundCritical illness polyneuropathy (CIP) and critical illness myopathy (CIM) are complications causing weakness of respiratory and limb muscles in critically ill patients. As an important differential diagnosis of Guillain-Barré syndrome (GBS), CIP and CIM should be diagnosed with caution, after a complete clinical and laboratory examination. Although not uncommon in ICU, CIP and CIM as severe complications of percutaneous nephrostolithotomy (PNL) have not been documented in literature.Case presentationA 48-year-old Chinese woman was referred to our hospital, complaining of occasional pain in the right lower back for one month. Lithiasis was diagnosed by ultrasonographical and radiological examinations on the urinary system. PNL was indicated and performed. The patient developed CIP and CIM on the fourth day after PNL. Early recognition and treatment of the severe complications contributed to a satisfactory recovery of the patient.ConclusionThis case expands our understanding of the complications of PNL and underscores the importance of differentiating CIP/CIM from GBS in case of such patients developing weakness after the treatment. Clinical characteristics and examination results should be carefully evaluated to make the diagnosis of CIP or CIM. Both anti-septic prophylaxis and control of hyperglycemia might be effective for the prevention of CIP or CIM; aggressive treatment on sepsis and multiple organ failure is considered to be the most effective measure to reduce the incidence of CIP/CIM.

Posterior Reversible Encephalopathy Syndrome and Guillain-Barré Syndrome after Head Injury: Case Report

“…While clinical symptoms such as tetraplegia or electromyogram are similar between CIP/CIM and GBS, bulbar palsy and albuminocytologic dissociation in CSF, both of which were clear in the patient, are more likely in GBS than in CIP/CIM. 23) Sepsis, acute respiratory distress syndrome or multiple organ failure are associated with CIP/CIM in intensive care unit, 23) none of which this patient had. Therefore, CIP/CIM was less likely in our patient.…”

Correspondence: Guillain-Barré syndrome and hemorrhagic fever with renal syndrome

“…We previously reported a case of critical illness polyneuropathy and myopathy with reversible tetraplegia after percutaneous nephrostolithotomy and septic shock [6]. The axonal variants of GBS might be difficult to distinguish from CIP due to the similar clinical manifestations and electrophysiological signs.…”