Mononeuritis multiplex as a presenting feature of Wegener granulomatosis: a case report

Peshin, Rohit; O’Gradaigh, Donncha

doi:10.1007/s10067-006-0413-0

Cited by 2 publications

(3 citation statements)

References 7 publications

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“…In our review of literature, we found that there has been only one case report which shares the presentation of foot drop that was in a biopsy proven vasculitis that however does not share the quick progression; as their patient had history of chronic sinusitis two years prior to the peripheral neuropathy development [2]. Their case was consistent with the Luigi Cattaneo et al study that declared in WG among other small disease vasculitis peripheral neuropathy usually develops after a prolonged course of sinusitis, lung manifestations or renal involvement priors to neurological disease.…”

Section: Discussionmentioning

confidence: 96%

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A peripheral neuropathy with unusual progression in Wegener's granulomatosis

Kazzaz¹,

Massien²

2013

IJCRI

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Introduction: We present a case of Wegener's granulomatosis (WG) with unique sequence of progression into a rare presentation of peripheral neuropathy; previously there has been one similar case. However, instead of the two years lag after sinusitis development our case manifested with peripheral neuropathy in a quick fashion. Also we have observed a chronological sequence of progression from infectious process into Wegener's granulomatosis. Case Report: We present a case of a 66yearold Caucasian male previously healthy who presented initially with symptoms of sinusitis and pneumonia, which in a span of three months presented with peripheral neuropathy advancing to left foot drop. Conclusion: In Wegener's granulomatosis, the symptoms of most prominence might not necessarily be the classical presentation of upper or lower respiratory involvement but could be neurological and does not always follow the course of chronic involvement before advancing to severe neurological consequence such as foot drop. In addition, the hypothesis that infections could have contributory role in development or is a factor in Wegener's granulomatosis is observed here in the chronological sequence of events from pneumonia to manifestation of the disease and nonetheless the seroconversion of CANCA to positivity.

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Section: Discussionmentioning

confidence: 96%

“…In span of three months, presentation of vasculitic peripheral neuropathy was evident as the main symptom of concern. There has been only one case in literature that shared the mononeuritis multiplex presentation but was associated with prolonged course of sinusitis over two years initially [2,3].…”

Section: Introductionmentioning

confidence: 99%

A peripheral neuropathy with unusual progression in Wegener's granulomatosis

Kazzaz¹,

Massien²

2013

IJCRI

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“…George et al [ 10 ] and Aftab et al [ 11 ] reported two similar cases of GPA but with additional renal dysfunction occurring during the course of the disease. Peshin et al [ 12 ] and Lew et al [ 13 ] also reported two such cases, but they had evidence of vasculitis on examination in the form of nailbed changes and Raynaud's phenomenon, respectively. Apart from these, there is one case report in German literature and one in a Portuguese journal on mononeuritis multiplex as the initial manifestation of GPA [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis (AAV) Masquerading As Mononeuritis Multiplex: A Case Report

Patel,

Sojitra

2023

Cureus

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Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of disorders that causes severe small-vessel inflammation with systemic manifestations. There are three subtypes of AAV, namely granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic GPA (EGPA). The most commonly affected organs are the upper and lower respiratory tract and the kidneys with occasional and varied neurological manifestations. Here we report a case of a 61-year-old female who presented with a one-month history of numbness, paresthesia, and asymmetric distal weakness of both lower limbs without any bladder or bowel involvement. Similar complaints appeared in her upper limbs three days prior to admission. She also suffered from myalgia, arthralgia, reduced appetite, and lost 8-10 kg weight over the past six months. Her nerve conduction study (NCV) revealed asymmetrical, predominantly motor, mixed, axonal and demyelinating polyneuropathy affecting both lower limbs, which was suggestive of mononeuritis multiplex. After a detailed workup, she tested strongly positive for cytoplasmic ANCA (c-ANCA). Although there was no clinical involvement of the respiratory tract, a contrast-enhanced computed tomography scan of the thorax and abdomen showed multifocal subpleural and lung parenchymal soft tissue lesions and mediastinal and bilateral hilar lymphadenopathy suggestive of a granulomatous lesion. She was diagnosed with the GPA variant of ANCA-associated vasculitis. Remission induction was achieved with high-dose methylprednisolone and cyclophosphamide along with alternate-day cotrimoxazole. Remission was maintained with tapering doses of steroid and mycophenolate mofetil with a slow but sustained recovery. On follow-up after one year, she walked without support with mild residual burning paresthesia in both feet. This case highlights the fact that neurological symptoms can be the presenting manifestation of AAV, and clinicians should have a high level of suspicion for AAV in patients presenting with mononeuritis multiplex, especially after ruling out common causes. By considering such etiologies, it may be possible to diagnose the condition at an earlier stage and initiate treatment to prevent potential pulmonary or renal damage.

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Mononeuritis multiplex as a presenting feature of Wegener granulomatosis: a case report

Cited by 2 publications

References 7 publications

A peripheral neuropathy with unusual progression in Wegener's granulomatosis

A peripheral neuropathy with unusual progression in Wegener's granulomatosis

Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis (AAV) Masquerading As Mononeuritis Multiplex: A Case Report

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