Severe, subacute axonal polyneuropathy due to hypophosphatemia

A 46-year-old man receiving tube feeding because of anorexia and weight loss developed progressive neurological symptoms initially resembling Guillain-Barré syndrome. Eventually axonal neuropathy due to severe hypophosphatemia was diagnosed. Hypophosphatemia can be caused by the so-called refeeding syndrome, which may occur in patients who start feeding after prolonged fasting. The neurological manifestations of hypophosphatemia are reversible if oral or intravenous suppletion of phosphate is started in time. Recognizing the refeeding syndrome is crucial in making a timely diagnosis.