Progressive muscular weakness due to subacute postinfectious polyradiculitis and myelitis

In a 67-year-old patient, generalised stable muscular weakness preexisting for several years became rapidly progressive within a few weeks prior to ho spitalisation. He died one month after admission from acute cardiocirculato ry failure. There was no history of muscular pain, clinical examination sho wed weak or absent tendon reflexes, hyposensibility of the dorsa of his fee t, fasciculations and myocloni of the muscles of the lower limbs as well as a generalised muscular atrophy. Polyneuropathy due to diabetes mellitus an d monoclonal IGG-kappa-type gammopathy were preexisting. CSF examination sh owed inflammatory cerebral fluid changes and further investigations reveale d inflammatory polyradiculopathy affecting mainly motor nerve fibres. There was evidence of a reactivated varicella-zoster infection in serum and in t he cerebrospinal fluid samples. The search for a tumour, vasculitis or a dr ug-related cause for this syndrome remained negative. Neuropathological exa mination at autopsy showed subacute polyradiculitis accompanied by myelitis . The most probable cause of this disorder is immune-mediated polyradiculit is after varicella-zoster infection.