A 32-Year-Old Man Is Brought to the Emergency Department Due

A 32-year-old man is brought to the emergency department due to weakness and tingling that started in his feet and is now at his knees.  A week ago, the patient noticed that his legs felt weak while climbing stairs.  Since then, the weakness has progressively worsened every day.  Today, he fell twice when attempting to walk.  Medical history is insignificant, except for a mild respiratory infection 2 weeks ago that resolved spontaneously.  The patient does not use tobacco, alcohol, or illicit drugs.  He takes no medications.  Vital signs are within normal limits.  Physical examination shows marked weakness in the distal muscles and moderate weakness in the proximal muscles in both legs.  Deep tendon reflexes are absent at the knees.  This patient's condition is most likely associated with which of the following?

A) Endomysial inflammatory infiltration
B) Endoneurial arteriole hyalinization
C) Endoneurial inflammatory infiltration
D) Mutations of a muscle structural protein gene
E) Toxin penetration through the blood-nerve barrier

Correct Answer:

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