Vasculitic Mononeuritis Multiplex May Be Misdiagnosed as Carpal Tunnel Syndrome

Abstract

Vasculitis is a group of disorders characterized by inflammation and destruction of blood vessels, resulting in ischemic injury to the involved tissue. Sometimes, peripheral neuropathy is one of the first symptoms of systemic vasculitis. Although the classic form of peripheral nervous system vasculitis is mononeuritis multiplex, it can also present as a mononeuritis. In this case report, the patient presented with progressive rapid onset numbness in her right hand for 2 months. She underwent carpal tunnel decompression surgery with initial diagnosis of acute carpal tunnel syndrome but failed to respond to the surgery, and two month later, she presented with foot drop. The final diagnosis was vasculitic mononeuritis multiplex. The present case report demonstrates the importance of identification of median mononeuritis as one of the first presentations of vasculitic disorders and distinction from acute carpal tunnel syndrome. The natural history of many of the systemic vasculitides is rapidly progressive, and they are likely to be fatal without early treatment. In this regard, timely diagnosis of vasculitis is critical because of the vital role of early immunosuppressive therapy in preventing multiorgan damage and decreasing mortality rate.

‘Carpal tunnel syndrome’ and ‘tennis elbow’ as prodromes for granulomatosis with polyangiitis (formerly Wegener’s granulomatosis)

“…To the best of our knowledge, this is the first reported case in which the musculoskeletal symptoms from GPA were attributed to epicondylitis. Incidences in which median neuropathy related to vasculitis was attributed to carpal tunnel syndrome have been reported previously,12 as can be expected given the rare incidence of vasculitides compared with mechanical overuse syndromes in the general population. This further emphasises the need to consider systemic vasculitides in the differential diagnosis for non-rheumatologists to enable early specialist referral and timely appropriate treatment.…”

Hypoglossal Nerve Palsy Following COVID-19 Vaccination in a Young Adult Complicated by Various Medicines

“…Mononeuritis multiplex is a rare form of cerebral nerve palsy caused by various factors, as the etiologies, infection, and autoimmunity are common. Herpes zoster and simplex are the predominant infections in the category of infection [ 1 , 2 ]. Among autoimmune causes, small-to-medium-sized vasculitis, such as an antineutrophil cytoplasmic antibody (ANCA)-related vasculitis and Sjogren’s syndrome, are common [ 1 , 2 ].…”

“…Herpes zoster and simplex are the predominant infections in the category of infection [ 1 , 2 ]. Among autoimmune causes, small-to-medium-sized vasculitis, such as an antineutrophil cytoplasmic antibody (ANCA)-related vasculitis and Sjogren’s syndrome, are common [ 1 , 2 ]. The progression of mononeuritis multiplex symptoms varies depending on the human body's etiology and immunological reactions [ 3 , 4 ].…”

“…The progression of mononeuritis multiplex symptoms varies depending on the human body's etiology and immunological reactions [ 3 , 4 ]. Severe cases may involve multi-extremity paralysis, which should be treated with intravenous immunoglobulin therapy, steroids, and plasma exchange, according to the etiology [ 2 , 5 ]. Thus, effective treatment requires the detection of etiology and rapid treatment.…”