A Case of Acute Autonomic and Sensory Neuropathy Accompanied by Respiratory Failure

ABSTRACT

Acute autonomic and sensory neuropathy (AASN) is a rare neuropathy characterized by the acute onset of autonomic dysfunction and objective sensory disturbances. A 33-year-old woman experienced generalized fatigue, urinary retention, and defecation difficulty with numbness around her mouth followed by a decreased pain sensation over her face and whole body, and respiratory difficulty with aspiration pneumonia. Neurological examination revealed bilaterally dilated fixed pupils, loss of sweating and lacrimation, orthostatic hypotension, and decreased sensation of all modalities with transient mild to moderate motor weaknesses. The muscle weakness may have been responsible for her respiratory failure as her respiratory distress was resolved in conjunction with improved general muscle power. Although the pathogenetic mechanism of AASN has been generally believed to be immune-mediated, the absence of immunoglobulin responsiveness and the negative results to various autoantibody tests in our case, raises questions against its autoimmune etiology. The patient showed slow progress of overcoming her autonomic dysfunction with relatively persistent sensory deficits.