Acute Demyelinating Polyneuropathy as Presentation of Hereditary Neuropathy With Liability to Pressure Palsies in a Patient Who Exercised Regularly in the Army

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Abstract

Acute generalized neuropathy as the presenting manifestation of hereditary neuropathy with liability to pressure palsies (HNPP) is rare. We report a 19-year-old Army recruit who exercised regularly for 9 months and presented with 2 weeks of numbness, tingling, and weakness in both upper and lower extremities, starting 2 weeks after influenza vaccination and 1 day after vigorous exercise. Based on acute onset, clinical examination and electrophysiological findings, Guillain–Barre syndrome was diagnosed, and intravenous immunoglobulin was administered with minimal improvement. The presence of high foot arches and scapular winging raised suspicion of HNPP, confirmed by genetic testing. The role of the influenza vaccine in the development of symptoms is discussed. This case highlights the fact that HNPP can present as an acute generalized neuropathy even in people who train regularly. Careful history, physical examination, and evidence of entrapment neuropathies in nerve conduction study can aid in the diagnosis.

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