History of Present Illness:
Approximately 4 weeks before his admission the patient began to notice sensory changes and distal weakness in his hands and feet following an upper respiratory infection. He also reported weakness of his arms and midline neck pain that radiated into both arms. During the acute care phase of his hospitalization, the patient was treated with two rounds of intravenous immunoglobulin (IVIG) infusions. Over a period of 3 weeks, his weakness progressed proximally through both legs and arms to his trunk and facial muscles. He was transferred to an inpatient rehabilitation facility for intensive speech, occupational, and physical therapy to maximize his communication skills, functional mobility, and ability to perform activities of daily living (ADL) before returning home with his family. At time of admission to inpatient rehabilitation, complications included atrial fibrillation, autonomic dysfunction, aspiration pneumonia, hyponatremia, panic attacks, dysphasia (requiring placement of a percutaneous endoscopic gastrostomy [PEG] tube and continuous feedings), and a 20-pound weight loss.