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Open Access Case report

Reversible tetraplegia after percutaneous nephrostolithotomy and septic shock: a case of critical illness polyneuropathy and myopathy with acute onset and complete recovery

Hai Li12, Li-Min Wu2, Xiang-Bo Kong1, Yi Hou1, Rui Zhao1, Hong-Yan Li1 and Hong-Liang Zhang2*

Author Affiliations

1 Department of Urology, The China-Japan Union Hospital of Jilin University, Changchun, China

2 Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Xinmin Street 71#, 130021, Changchun, China

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BMC Nephrology 2013, 14:36  doi:10.1186/1471-2369-14-36

Published: 14 February 2013

Abstract

Background

Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) are complications causing weakness of respiratory and limb muscles in critically ill patients. As an important differential diagnosis of Guillain-Barré syndrome (GBS), CIP and CIM should be diagnosed with caution, after a complete clinical and laboratory examination. Although not uncommon in ICU, CIP and CIM as severe complications of percutaneous nephrostolithotomy (PNL) have not been documented in literature.

Case presentation

A 48-year-old Chinese woman was referred to our hospital, complaining of occasional pain in the right lower back for one month. Lithiasis was diagnosed by ultrasonographical and radiological examinations on the urinary system. PNL was indicated and performed. The patient developed CIP and CIM on the fourth day after PNL. Early recognition and treatment of the severe complications contributed to a satisfactory recovery of the patient.

Conclusion

This case expands our understanding of the complications of PNL and underscores the importance of differentiating CIP/CIM from GBS in case of such patients developing weakness after the treatment. Clinical characteristics and examination results should be carefully evaluated to make the diagnosis of CIP or CIM. Both anti-septic prophylaxis and control of hyperglycemia might be effective for the prevention of CIP or CIM; aggressive treatment on sepsis and multiple organ failure is considered to be the most effective measure to reduce the incidence of CIP/CIM.

Keywords:
Critical illness polyneuropathy; Critical illness myopathy; Percutaneous nephrostolithotomy; Sepsis; Guillain-Barré syndrome