Critical neurological conditions: severe toxic polyneuropathy with the development of respiratory failure and rhabdomyolysis

Abstract

This is a description of the clinical case of severe toxic polyneuropathy in a 52-year-old man, caused by a confirmed exogenous intoxication with amphetamine. The clinical picture was remarkable for muscle weakness in different muscle groups: neck, back, arms and legs, respiratory muscles; as well as for the respiratory failure (requiring mechanical ventilation), rhabdomyolysis, mild nephropathy, liver cytolysis. A differential diagnosis was made between myasthenia gravis, myopathy, amyotrophic lateral sclerosis. After a course of intensive therapy, almost complete regression of symptoms took place, as well as the improvement of electroneuromyographic pattern. Taking into account a rapid partial regression of symptoms in the course of the disease, as well as the results of a neurophysiological study, an immunochromatographic urine drug screen was performed, positive for amphetamine. This clinical case demonstrates "rare" complications of amphetamine use to be kept in mind during a diagnostic search.

Keywords

• toxic polyneuropathy
• respiratory failure
• amphetamine
• mechanical ventilation
• rhabdomyolysis