Clinical Reasoning: A 41-Year-Old Man Presenting With Right Foot Tingling

The diagnostic evaluation of progressive, multifocal sensory neuropathy can be challenging and prone to misdirection without a broad differential diagnosis and a careful clinical history. We present a 41-year-old healthy man with insidious onset of right foot paresthesia, which gradually extended to his left foot and right hand over several months. This case illustrates a systematic clinical reasoning approach to multifocal neuropathy, culminating in the unexpected diagnosis of a treatable cause for neuropathy. The case underscores the importance of maintaining diagnostic openness to rare but treatable causes in the evaluation of atypical neuropathy presentations.