Case report

A middle-aged patient with a history of chronic inflammatory demyelinating polyneuropathy of over 20 years presented with new onset of numbness of the penis and impaired erections. Review of the clinical history revealed an initial presentation in his early 20s with an unsteady gait and numbness of the feet, following which he developed progressive asymmetric distal weakness and sensory loss of his lower and upper limbs. Previous electrophysiological studies had demonstrated a demyelinating sensorimotor polyneuropathy with absent sensory nerve action potentials and markedly decreased motor nerve conduction velocities (8 m/s in the right median nerve). Raised protein content (3 g/l) had been established on cerebrospinal fluid analysis and sural nerve biopsy revealed ‘onion bulb’ formation …