A 38-year-old man had a subacute progressive afebrile illness characterized by right thigh numbness and itching followed by right lower back pain, left foot numbness and itching, left lower extremity burning pain, left hand numbness, and deep left elbow and upper back pain. Subsequently, he had tingling of his right toes and severe stabbing pain in his left hand. This was followed by left arm and right thigh weakness, left face weakness, and then right face weakness. He then complained of bilateral circumoral numbness. During the course of his illness, he lost 25 pounds. Two months prior to onset of this illness, he had high fever, chills, and night sweats lasting 2 days.

Our patient presented with 6 months of multifocal sensory neuropathic/radiculopathic features, and pain followed by multiple cranial neuropathies. Sensory symptoms and signs followed a peripheral or cranial nerve distribution, and his weakness was of a lower motor neuron type. Neurophysiologic studies showed evidence of a patchy sensory motor peripheral neuropathy consistent with mononeuritis multiplex.