Abstract
A 32-year-old man developed a rash on his body and extremities following acute fever of a few days duration, and also noticed pain and spontaneous tingling sensations in his lower extremities. Because severe pneumonia with dyspnea and low arterial blood oxygen concentration were found on examination, he was admitted and treated. After recovering from pneumonia in two months, he complained of abdominal symptoms, such as constipation, nausea and vomiting, spontaneous tingling sensations in the lower extremities, and orthostatic dizziness and fainting. On neurological examination, a mild to moderate muscle weakness was found in the distal muscles of both extremities. The ankle jerk was absent. Both superficial and deep sensations were moderately to severely decreased in the feet with positive Romberg's sign. Constipation and vomiting with nausea were noted. Clinical and laboratory examinations revealed marked orthostatic hypotension and hypohidrosis. Motor and sensory conduction studies indicated the presence of axonal degeneration and segmental demyelination and remyelination in the limbs nerves. CSF examination indicated that protein was 150 mg/dl and the cell count to be 18/mm³. Titer of antibody to rubella virus was significantly elevated. There were no other abnormalities to indicate the cause of motor, sensory and autonomic neuropathies. Therefore, the diagnosis of acute polyradiculoneuropathy with autonomic disturbances after rubella infection, which is rare in the literature, was made.
