CASE PRESENTATION: 63 year old male with history of alcoholic cardiomyopathy, non small cell lung cancer s/p partial lobectomy, chronic cavitary aspergilliosis, MAC s/p treatment, and chronic adrenal insufficiency. He presented to the ED because of chest pain and dyspnea, and was admitted for further management of PE. He denied fevers, chills, rash, cough, edema, or recent diarrhea. His hospital course was complicated by rapid development of dysphagia, descending areflexic quadriparesis, urinary retention, decreased rectal tone, and diaphragmatic weakness requiring transfer to MICU for intubation. Cervical imaging was unremarkable; MRI was negative for ischemic spinal cord injury. LP was not obtained due to concurrent anticoagulation. IVIG was empirically given for suspected variant GBS. Initial EMG suggested axonal loss and segmental demyelination. EMG after treatment was remarkable for normal phrenic nerve function and recovering motor response, confirming the diagnosis. He recovered diaphragmatic function and was eventually discharged to a rehabilitation facility.