Mononeuritis Multiplex and Peripheral Neuropathy in Wegener's Granulomatosis

1Community Regional Medical Center, Fresno, CA
2Charleston Area Regional Medical Center, Charleston, WV
3Charleston Area Regional Medical Center. Charleston, WV
4Charleston Area Regional Medical Center, Charleston, WV

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 206

Case Presentation:

A 69‐year‐old woman was hospitalized with a 4‐month history of generalized weakness, paresthesias, and bilateral lower‐extremity pain. Her past medical history was significant for hypertension, dyslipidemia, and surgically treated ovarian cancer Review of systems was positive for decreased appetite and postmenopausal bleeding. Physical exam was unremarkable, except for the neurological exam, which revealed diminished light touch, pain/temperature sensation, vibratory sensation, and proprioception up to The calf in bilateral lower extremities and up to her wrists in the upper extremities. Motor strength was found to be 3/5 in proximal muscles. Reflexes were diminished in the upper extremity and were absent in the lower extremity. Abnormal laboratory values included an elevated ESR of 121 mm/hr and urinalysis showing moderate blood without red cell casts. Complement levels were normal, and CSF studies were negative for Guillain‐Barre syndrome. MRI of the lumbosacral and cervical spine was unremarkable. Nerve conduction revealed a mixed motor and sensory axonal polyneuropathy with slowing of conduction velocities. Her symptoms continued to worsen, and she eventually developed bilateral foot drop. Renal function also worsened, with a creatinine of 3.4 mg/dL. Given the high index of suspicion for vasculitis, pulse‐dose IV methyl prednisolone was started. Although a sural nerve biopsy was negative for vasculitis, immunological studies showed positive cANCA antibodies. An extensive paraneoplastic workup turned out to be negative, and the diagnosis of Wegener's granulomatosis (WG) was confirmed with renal biopsy. She was continued on steroids and plasmapheresis and was later started on cyclophosphamide with improvement in renal functions.

Discussion:

The classic initial presentation of WG involves the upper airways, lungs, or kidneys. The peripheral nervous system is eventually affected in a significant number of patients and can be the sole symptom, occurring months before the diagnosis of WG is made. We report This case of WG presenting predominantly with neurological symptoms and wish to highlight a learning point, as WG rarely presents as peripheral neuropathy, and mononeuritis multiplex and can be overlooked. Patients with vasculitic neuropathies suffer greater disease extent and more severe organ manifestations. By considering such etiologies, it may be possible To discover the disease at an earlier stage in order to initiate treatment To prevenT further renal or pulmonary damage.

Conclusions:

Peripheral neuropathy can be the earliest manifestation of WG, followed by pulmonary or renal involvement, and it is imponant to investigate underlying WG in These cases, as These patients suffer from more severe disease course.

Author Disclosure:

W. Aftab, Community Hospitalist Medical Group, employment; K. Manzoor, Charleston Area Medical Center, employment; K, John, none; A. Rahman, none.

To cite this abstract:

Aftab W, Manzoor K, John K, Rahman A. Mononeuritis Multiplex and Peripheral Neuropathy in Wegener's Granulomatosis. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 206. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/mononeuritis-multiplex-and-peripheral-neuropathy-in-wegeners-granulomatosis/. Accessed May 23, 2019.

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