Chronic inflammatory demyelinating polyneuropathy complicated by pre-eclampsia progressing to HELLP syndrome and pulmonary embolism: A case report

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune mediated peripheral neurologic disease characterized by symmetric, ascending progressive limb weakness and paresthesia. It is a rare and diagnostically challenging condition. Pregnancy-induced CIDP is especially rare, with few case series describing treatment courses, pregnancy outcomes and complications. This report concerns a case of a 20-year-old primigravida with CIDP who was initially misdiagnosed with bilateral Bell's palsy. Symptoms progressively worsened to include ascending limb weakness, allodynia, urinary retention and fecal incontinence; she later met criteria for CIDP. Her pregnancy went on to be complicated by prolonged hospitalization and pre-eclampsia; after induction of intravenous immunoglobulin therapy, she developed acute pulmonary embolism and HELLP syndrome, and required emergent C-section delivery. The diagnosis, treatment and management of severe pregnancy complications associated with CIDP are described.