28M painful polyneuropathy, skin lesions and recurrent quadriparesis, alcoholism

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A 28 yr old male came with chief complaints of:
- Weakness of both lower limbs since 15 days
- multiple ulcers all over the body since 5 days

HOPI:
Pt. was apparently asymptomatic 15 days back, then he noticed weakness in both lower limbs when he was trying to wake up in the morning, which was sudden in onset, gradually progressive, associated with b/l limb pains. 

H/o difficulty in climbing stairs, standing from sitting position. No h/o difficulty in combing, wearing T shirt, buttoning/unbuttoning.

H/o high grade, intermittent fever since 5 days. Associated with chills, generalized weakness.

H/o ulcers all over the body since 5 days, initially blisters, later ruptured.

No h/o difficulty in coitus

Patient then went to local RMP, where he was given Diclofenac and Monocef injections for 3 days.  

PAST HISTORY:
H/o similar complaints of weakness of both lower limbs 4 times in the past - diagnosed as ?hypokalemic periodic paralysis

N/k/c/o DM, HTN, CAD, CVD, epilepsy, thyroid disorders

PERSONAL HISTORY:
Occupation: Municipality worker
Appetite: Normal
Diet: Non-veg
Bowel and bladder movements: Regular
Allergies: None
Habits: Regular Alcohol consumption - 360-720ml/day since 9 yrs

FAMILY HISTORY: Not significant

GENERAL EXAMINATION:
Pt is conscious, coherent, cooperative
No visible signs of pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedal edema
Temp: 101.1F
PR: 78bpm
RR: 20cpm
BP: 120/70 mmHg
SpO2: 96% @ RA
GRBS: 142 mg%

SYSTEMIC EXAMINATION:
CVS: S1 S2 heard, no murmurs
RS: NVBS +
P/A: soft, non tender
CNS:
GCS: E4V5M6
Power:    Rt    Lt
UL         5/5    5/5
LL          3/5   3/5
Tone:
UL          N       N
LL          N       N
Reflexes:
B            2+      2+
T            2+      2+
S             -         -
K            -          -
A            -          -
Pl       Flexion    Flexion

No cerebellar signs
Gait - could not be elicited
One fever spike every night since day of admission
With tlc trends as 14000--20000---20000 on piptaz


PROVISIONAL DIAGNOSIS:
Paraplegia secondary to ?peripheral neuropathy secondary to alcohol







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