TY - JOUR
T1 - Idiopathic polyneuropathy with neurogenic autonomic failure – an early manifestation of Lewy body disease? a case report
AU - Andersen, Naja Helt
AU - Borghammer, Per
AU - Doppler, Kathrin
AU - Gottrup, Hanne
AU - Knudsen, Karoline
AU - Kuzkina, Anastasia
AU - Van Den Berge, Nathalie
AU - Otto, Marit
AU - Terkelsen, Astrid Juhl
PY - 2025/12
Y1 - 2025/12
N2 - With the present case we suggest that idiopathic large-fiber polyneuropathy with autonomic failure, pathological cardiac [123I]Metaiodobenzylguanidine (MIBG) scintigraphy and α-synuclein positivity in cutaneous autonomic nerves is a prodromal manifestation of body-first Lewy body disease (LBD).Case Presentation: A previously healthy 74-year-old man presented with painful polyneuropathy and orthostatic intolerance. Phenotypic characterization demonstrated small- and large-fiber sensory-motor-autonomic polyneuropathy, cardiac sympathetic denervation and cardiovagal and cardiovascular adrenergic dysfunction. Despite thorough examination and exclusion of diabetes, primary- and hereditary transthyretin amyloidosis, no underlying cause was found. Interestingly, LBD was suspected due to abnormal cardiac MIBG scintigraphy, constipation, hyposmia, REM sleep behavior disorder (RBD), and mild cognitive impairment. Seed amplification assay (SAA) for pathological α-synuclein was positive in a skin biopsy (neck) with deposits localized in the autonomic nerves based on immunohistochemistry. He was clinically diagnosed with mild dementia with Alzheimer’s Disease (AD) pathology. However, given the presence of severe autonomic dysfunction, RBD, pathological α-synuclein in addition to AD pathology, dual pathology with Lewy bodies (representing a body-first LBD) should be considered. Conclusion: This case highlights the importance of evaluating patients with idiopathic large-fiber polyneuropathy with autonomic failure for underlying LBD. We propose that both neuropathy and cardiac denervation may stem from the widespread peripheral neurodegeneration associated with pre-motor body-first LBD, although there is no direct evidence of causality. In this case, with idiopathic small- and large-fiber sensory-motor-autonomic neuropathy and abnormal MIBG scintigraphy, detection of α-synuclein in cutaneous autonomic nerves, supports our proposal. Thus, we suggest idiopathic polyneuropathy with autonomic failure to represent a non-motor prodromal manifestations in LBD.
AB - With the present case we suggest that idiopathic large-fiber polyneuropathy with autonomic failure, pathological cardiac [123I]Metaiodobenzylguanidine (MIBG) scintigraphy and α-synuclein positivity in cutaneous autonomic nerves is a prodromal manifestation of body-first Lewy body disease (LBD).Case Presentation: A previously healthy 74-year-old man presented with painful polyneuropathy and orthostatic intolerance. Phenotypic characterization demonstrated small- and large-fiber sensory-motor-autonomic polyneuropathy, cardiac sympathetic denervation and cardiovagal and cardiovascular adrenergic dysfunction. Despite thorough examination and exclusion of diabetes, primary- and hereditary transthyretin amyloidosis, no underlying cause was found. Interestingly, LBD was suspected due to abnormal cardiac MIBG scintigraphy, constipation, hyposmia, REM sleep behavior disorder (RBD), and mild cognitive impairment. Seed amplification assay (SAA) for pathological α-synuclein was positive in a skin biopsy (neck) with deposits localized in the autonomic nerves based on immunohistochemistry. He was clinically diagnosed with mild dementia with Alzheimer’s Disease (AD) pathology. However, given the presence of severe autonomic dysfunction, RBD, pathological α-synuclein in addition to AD pathology, dual pathology with Lewy bodies (representing a body-first LBD) should be considered. Conclusion: This case highlights the importance of evaluating patients with idiopathic large-fiber polyneuropathy with autonomic failure for underlying LBD. We propose that both neuropathy and cardiac denervation may stem from the widespread peripheral neurodegeneration associated with pre-motor body-first LBD, although there is no direct evidence of causality. In this case, with idiopathic small- and large-fiber sensory-motor-autonomic neuropathy and abnormal MIBG scintigraphy, detection of α-synuclein in cutaneous autonomic nerves, supports our proposal. Thus, we suggest idiopathic polyneuropathy with autonomic failure to represent a non-motor prodromal manifestations in LBD.
KW - Alpha-synuclein seed amplification assay
KW - Alzheimer's Disease
KW - Cardiac 123I-MIBG
KW - Lewy body disease
KW - Mild cognitive impairment
KW - Neurogenic autonomic failure
KW - Polyneuropathy
KW - REM-sleep behavior disorder
UR - https://www.scopus.com/pages/publications/105019114221
U2 - 10.1186/s12883-025-04414-y
DO - 10.1186/s12883-025-04414-y
M3 - Journal article
C2 - 41107742
SN - 1471-2377
VL - 25
JO - BMC Neurology
JF - BMC Neurology
IS - 1
M1 - 432
ER -