Critical illness myopathy and neuropathy (CRI.MY.NE.) after mitral valve replacement: A case report

In its typical presentation, critical illness myopathy and neuropathy (CRI.MY.NE.) is a sensory-motor axonal polyneuropathy and is a common consequence of systemic inflammatory response syndrome (SIRS) and multiple organ failure (MOF). It is frequently found in patients with a long stay in intensive care unit (ICU), and subjected to intravenous curare, aminoglycoside antibiotic or steroid administration. It should be suspected in ICU patients who, after a period of days or weeks, suffer from various degrees of limb weakness or cannot be weaned from the ventilator despite the absence of pulmonary or cardiac causes of respiratory failure. CRI.MY.NE. can be easily recognized at its onset by means of neurophysiologic studies such as needle electroneuromyography (ENMG). It can be cured only if its causes are treated and proper rehabilitation therapy is instituted. We present the case of a 75 years old woman who, after mitral valve replacement for mitral valve insufficiency, suffered from CRI.MY.NE. in her postoperative ICU stay. Although the illness was recognized only lately, and both proper treatment of its causes and application of a proper motor and cardiopulmonary rehabilitative protocol were accordingly delayed, the patient recovered fully from her illness.