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electrophysiological features, CSF analysis and sural nerve biopsy. Molecular studies for hereditary
neuropathies were unremarkable. At age 33 he had a severe relapse leading to a subacute flaccid, areflexic
tetraparesis unresponsive to IVIg. He was then successfully treated with plasma exchange and intravenous
corticosteroids. Subsequently he became corticosteroid-dependent needing chronic treatment with oral
prednisone (25 mg every other day). Unfortunately, he developed bilateral cataract, right hip osteonecrosis
and cushingoid appearance. Therefore, we switched the treatment to pulsed intravenous methylprednisolone
(1 g daily for three consecutive days every two months). After one year of this schedule, the neuropathy is
excellently controlled (apart from mild distal leg weakness) and corticosteroid toxicity is minimized, with
improvement of hip osteonecrosis and regression of the cushingoid features.

In conclusion, corticosteroids are cheaper, easier to use, and much more widely available than IVIg. They
[2]
have been suggested to lead to long-term remission more often than IVIg . Furthermore, even if there are
no significant differences in response and remission rate between these two regimens, pulsed intravenous
[2]
corticosteroids have lower rates of serious adverse effects than long-term daily use . Therefore, in our
opinion pulsed intravenous methylprednisolone should be considered in CIDP patients, especially in non-
responders to IVIg. In fact, it may represent the therapy of choice in these patients.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study and performed data analysis and
interpretation: Orsucci D

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
The author declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2019.

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