Simultaneous combined central and peripheral demyelination with acute inflammatory demyelinating polyradiculoneuropathy and short segment myelitis

Combined central and peripheral demyelination (CCPD) has been proposed to describe the occurrence of demyelination in both central and peripheral nervous systems. The aetiopathogenesis of combined demyelination is unknown, but the possibility of a shared pathogenic epitope has been suggested. Although it has been described in paediatric patients, reports of simultaneous onset CCPD with short segment myelitis among adults are scarce. We report a case of simultaneous onset monophasic CCPD in an adult who developed both Guillain-Barre syndrome and short segment spinal cord demyelination that responded to immunomodulation with intravenous immunoglobulins and plasmapheresis. The patient also had evidence of chronic thyroiditis which supports an autoimmune aetiopathogenesis of CCPD. Differentiating this diagnosis from multiple sclerosis has therapeutic implications.