Treatment-resistant chronic inflammatory demyelinating polyneuropathy (CIDP) with visual manifestations – a case report

<h3></h3> Neuro-ophthalmic involvement in chronic inflammatory demyelinating polyneuropathy (CIDP) is an uncommon manifestation. CIDP is a rare autoimmune disease characterised by proximal and distal symmetrical muscle weakness lasting longer than eight weeks. This case report describes extensive and severe CIDP in a 55-year-old patient presenting to the acute neurology ward with new-onset reduced vision, facial weakness and painful leg spasms. Neurological upper and lower limb and cranial nerve examinations revealed unilateral reduced visual acuity, cranial nerve 3,4, and 6 abnormalities, reduced power in both hands and legs, and paralysis of the right leg. Nerve conduction studies and antibody testing were conducted to confirm the diagnosis. The patient had previously been treated with multiple steroid regimens and IVIG trials, however, did not respond to these. It was decided that it was best to monitor his condition and refer him to the neuro-ophthalmology clinic for further investigation due to recurrent visual symptoms. This case demonstrates a rare presentation of treatment-resistant CIDP. It is crucial to explore alternative therapies to help improve patient outcomes. Additionally, neuro- ophthalmic involvement is still poorly understood in the case of CIDP. This case therefore highlights the importance of monitoring patients for such complications to guide treatment.