“F” waves were absent in all the four limbs. There was mild reduction in conduction velocity (38.7 m/s). Electrophysiological study of the right median nerve revealed normal latency (2.5 ms at wrist and 5.73 ms at elbow), reduced compound muscle action potential (0.5 mv at wrist and 0.3 mv at elbow) associated with similar changes in the area without any temporal dispersion. Cerebrospinal fluid (CSF) examination showed clear appearance negative for xanthochromia absent coagulum 15 cells/cumm (lymphocytes) protein, 69.9 mg/dl and sugar, 66 mg/dl. Investigations showed normal complete blood count and basic metabolic panel. Plantar reflexes were down going bilaterally. The power was grade 3/5 in both proximal and distal group of muscles of both lower and left upper limb.
Motor examination showed normal bulk, decreased tone in both lower limbs and left upper limb, whereas tone in right upper limb was normal. All cranial nerves were intact with normal fundi. Neurological examination showed that the patient was well oriented. There was no history of difficulty in swallowing and no deviation in the angle of the mouth. She has been having moderate fever for the past 2 days and developed difficulty in walking, climbing up the stairs, and getting up from sitting position. She noticed localized swelling and redness few minutes after the sting. A 3-year-old girl, belonging to lower socioeconomic status, without any remarkable medical history was brought by her mother to the office after multiple honey bee stings all over the body 5 days ago.
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