Clinical presentation

A 72-year-old female was admitted to our hospital because of abnormal lung shadows. Two years before admission, she had complained of paraesthesia in her hands. A gait disturbance appeared a year later and gradually worsened resulting in her losing the ability to walk altogether. She had also become constipated and developed a urinary disorder.

She had undergone total gastrectomy for gastric cancer 15 years ago and had received a blood transfusion at that time. On physical examination, she presented with muscle weakness in all four extremities, thermal hypoesthesia, an inability to sense vibration and dysautonomia.

She had no fever. Laboratory findings indicated high lysozyme. Purified protein derivative (PPD) skin test was negative (table 1). MRI revealed T2 high-intensity areas in the …