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NEUROLOGY 1996;46:822-824
Chronic inflammatory demyelinating polyneuropathy
(CIDP) is an acquired autoimmune disorder of unknown cause. CIDP most often occurs alone and not as a complication of other disorders but may accompany osteosclerotic myeloma and other plasma cell dyscrasias, human immunodeficiency virus (HIV) infection, and, rarely, systemic lupus erythematosus (SLE). [1] CIDP has not been associated with solid tumors and is not considered a direct or remote effect of cancer.
We report three patients with CIDP and malignant melanoma. The likelihood of a direct association is increased by the shared antigens between peripheral nerve and melanoma [2-4] and the appearance of demyelinating neuropathy after melanoma immunotherapy. [5,6]
Case reports.
Patient 1.
A 62-year-old man developed ascending leg numbness with paresthesias and progressive leg weakness. Four months after onset, he was unable to use stairs or get out of a chair without assistance because of weakness. At that time he had mild facial weakness, moderate limb weakness (proximal greater than distal), and areflexia. There was moderate loss of all sensory modalities in the distal limbs. He had patchy vitiligo, which had been present for 1 year.
The CSF protein was elevated to 104 mg/dl with no cells. Electrophysiologic studies were characteristic of an acquired demyelinating polyneuropathy Table 1. Other laboratory studies were normal, including a sedimentation rate, serum and urine immunoelectrophoresis with immunofixation, HIV serology, thyroid function studies, rheumatoid factor, and ANA. A skeletal survey was normal. Serum from this patient was assayed by ELISA for reactivity with myelin-associated glycoprotein (MAG) or GM1 ganglioside using previously described techniques. [7,8] Triplicate readings for his anti-MAG reactivity (0.157) and anti-GM1 ganglioside activity (0.124) did not differ from controls (0.137 and 0.140, respectively).
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Table 1. …
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