The burden of chronic inflammatory demyelinating polyradiculoneuropathy overdiagnosis in Egypt: a retrospective study

Abstract

Background: CIDP misdiagnosis is frequent worldwide. There is no report addressing the burden of this problem in Africa and the middle East. The aim was to study the impact of CIDP overdiagnosis in a middle-income country, and to discuss diagnostic pitfalls. This is a retrospective study that was conducted in the period from July 2024 to August 2025. EAN/PNS 2021 criteria for CIDP and variants were applied to confirm the diagnosis. Results: Forty-five patients were referred for the evaluation of neuropathy. Twenty-one patients had a referral diagnosis of CIDP (46.7%), but only 4/21 (19%) patients met the criteria for typical CIDP. Alternative diagnoses for overdiagnosed patients included ALS, DN, CMT1A, GBS, DLRPN, L5-S1 radiculopathy, myopathy, and unspecified AN. Interestingly, some cases did not have neuropathy at all. All misdiagnosed patients were evaluated and diagnosed initially by non-nerve specialists. Pain and weakness were frequent symptoms among misdiagnosed patients. Most patients had pure or predominant axonal features on NCS. Overdiagnosed patients had a delayed diagnosis of their true condition with a median diagnostic delay of 30 months. All overdiagnosed patients received ≥ 1 immunotherapy. Conclusion: Frequency of CIDP among neuropathy patients was low, and overdiagnosis was common in our cohort. Although widely available, diagnostic criteria were not applied. Other factors contributing to overdiagnosis included over-reliance on nebulous symptoms and subjective changes following immunotherapy, and overinterpretation of equivocal tests. Overdiagnosis resulted a diagnostic delay and unnecessary immunotherapy utilization. This would create an economic burden in a country with limited resources. Nationwide specialized neuropathy clinics are pivotal for an efficient diagnosis.