SHM Converge Scientific Abstract ePoster Gallery-A Case of Severe Polyneuropathy Caused by Multiple Micronutrient Deficiencies

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This case describes a 57-year-old woman with alcohol and tobacco use disorders, renal cell carcinoma, depression, and hypertension who developed progressive bilateral lower-extremity weakness along with nausea, vomiting, diarrhea, and weight loss. Over three hospital admissions, her symptoms worsened and were initially attributed to diverticulitis, neuropathic pain/somatization, and later possible Guillain-Barré syndrome (GBS). She received IVIG during the second admission with temporary improvement.<br /><br />During a subsequent admission for worsening weakness, positive ANA and SSA results raised concern for Sjögren’s syndrome, prompting transfer for further evaluation. However, extensive neurologic and systemic workup identified multiple micronutrient deficiencies, including low folate, vitamin D, copper, zinc, and vitamin B6. EMG/NCS studies showed severe axonal sensorimotor polyneuropathy, and CSF revealed elevated protein with minimal cells. Schirmer’s test showed mild/moderate dry eye, and salivary gland biopsy showed only mild lymphoplasmacytic inflammation, making Sjögren’s less convincing. Additional autoimmune, infectious, paraneoplastic, porphyria, and heavy metal studies were largely negative.<br /><br />Given her history of alcohol use disorder, nutritional deficiencies, and electrophysiologic findings, she was diagnosed with Acute Nutritional Axonal Neuropathy (ANAN), a rare cause of severe polyneuropathy that can mimic GBS. Her case highlights that ANAN is associated with micronutrient deficiency and can present with ascending weakness and sensory loss. Early recognition is important because prognosis depends on prompt diagnosis and repletion of deficiencies.

Asset Subtitle

Bisini Panicker

Meta Tag

Author List Bisini Panicker, Iqra Arshad

Category Clinical Vignettes

Concept Acute Nutritional Axonal Neuropathy

Concept Polyneuropathy

Concept Micronutrient Deficiency

Concept Ascending Weakness

Concept Sensory Loss

Distinguished Non-Finalist

Presenter Organization SSM Health/St. Louis University Hospital

Presenting Author Bisini Panicker

Track Adult

Keywords

acute nutritional axonal neuropathy

ANAN

polyneuropathy

micronutrient deficiencies

Guillain-Barré syndrome

axonal sensorimotor neuropathy

alcohol use disorder

vitamin B6 deficiency

copper deficiency

Sjögren’s syndrome

Acute Nutritional Axonal Neuropathy

Polyneuropathy

Micronutrient Deficiency

Ascending Weakness

Sensory Loss