Differential Diagnosis for Extremities Weakness in Immunocompromised Patients
Single Most Likely Diagnosis
- Guillain-Barré Syndrome: An autoimmune disorder that can be triggered by infections, often seen in immunocompromised patients, leading to rapid onset of muscle weakness, which can start in the extremities.
Other Likely Diagnoses
- Progressive Multifocal Leukoencephalopathy (PML): A rare and often fatal viral disease caused by the JC virus that affects the brain and leads to neurological symptoms, including weakness, in immunocompromised individuals.
- CMV Neuropathy: Cytomegalovirus (CMV) infection can cause neuropathy, leading to extremity weakness, particularly in patients with advanced immunosuppression, such as those with HIV/AIDS or post-transplant patients.
- Toxoplasmosis: In immunocompromised patients, especially those with HIV/AIDS, toxoplasmosis can reactivate and cause neurological symptoms, including weakness, due to the formation of brain lesions.
Do Not Miss Diagnoses
- Spinal Cord Compression: Due to metastatic cancer, abscess, or hematoma, which can present with acute onset of extremity weakness and is a medical emergency requiring prompt intervention.
- Botulism: Although rare, botulism can occur in immunocompromised patients, especially if they have gastrointestinal abnormalities, and leads to descending paralysis starting with cranial nerves but can progress to extremity weakness.
- West Nile Virus Neuroinvasive Disease: Can cause acute flaccid paralysis, among other neurological manifestations, in immunocompromised individuals exposed to the virus.
Rare Diagnoses
- Subacute Combined Degeneration (Vitamin B12 Deficiency): Can lead to neurological symptoms, including weakness in the extremities, due to demyelination in the spinal cord, more common in patients with malabsorption or dietary deficiencies.
- Lyme Disease (Neuroborreliosis): In its late stage, can cause neurological symptoms, including weakness, although this is less common in immunocompromised patients compared to the general population.
- HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP): A rare condition caused by the human T-lymphotropic virus 1 (HTLV-1), leading to progressive spastic paraparesis or paraplegia, more commonly seen in endemic areas.