Beyond Acute Sensory Ataxic Neuropathy: A Chronic Immune-Mediated Neuropathy Associated With GD1b Ganglioside Antibodies

Chronic immune-mediated neuropathy associated with GD1b ganglioside antibodies is typically framed asan acute, monophasic sensory ataxic process, yet this view may not capture the full clinical spectrum. Wedescribe a case of chronic, progressive immune-mediated neuropathy with GD1b antibody positivitycharacterized by mixed demyelinating and axonal large-fiber involvement, progressive weakness withactivity-dependent tremor, prominent proprioceptive dysfunction, and severe multisystem autonomicdysfunction. The course included lifelong immune abnormalities, extensive exclusion of alternativeetiologies, lack of response to first-line immunotherapy, and objective neurologic and autonomic findingsthat evolved over time rather than acutely. This case highlights limitations of an acute-only classification ofGD1b-associated neuropathy and supports consideration of a chronic, autonomic-predominant phenotypewith implications for diagnostic recognition and access to immunomodulatory treatment.