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Multiple mononeuritis

Elisabetta Chessa, Matteo Piga, Alberto Floris, Alessandro Mathieu, Alberto Cauli
Demyelinating syndrome secondary to systemic lupus erythematosus (DS-SLE) is a rare encephalomyelitis burden with a high risk of disability and death. We report on a 49-year-old Caucasian woman with systemic lupus erythematosus (SLE) complicated by severe cognitive dysfunction, brainstem disease, cranial nerve palsies, weakness and numbness in limbs and multiple discrete magnetic resonance imaging (MRI) areas of damage within the white matter of semioval centers, temporal lobe, external capsule, claustrum, subinsular regions and midbrain...
2017: Open Access Rheumatology: Research and Reviews
Nurashikin Mohammad, Wan Syamimee Wan Ghazali
We report a case of 28-year-old Malay woman who initially presented with multiple joints pain with underlying poorly controlled asthma since her childhood. She was treated as seronegative arthritis. However, the involvement of joints, asthma and high-eosinophil counts raised suspicion of Churg-Strauss syndrome. This disease is undoubtedly rare in Malaysians or even in Asian populations. After appropriate therapy was delivered for the correct diagnosis her clinical condition improved. She is currently receiving maintenance treatment...
May 27, 2017: BMJ Case Reports
Cédric Rochepeau, Yvan Jamilloux, Sebastien Kerever, Camille Febvay, Laurent Perard, Christiane Broussolle, Carole Burillon, Laurent Kodjikian, Pascal Seve
AIMS: To determine the long-term visual and systemic outcomes of uveitis patients with biopsy-proven sarcoidosis. METHODS: A retrospective study of biopsy-proven sarcoid uveitis, with a 3-year minimum follow-up, seen at Lyon University Hospital, between April 2004 and January 2016. RESULTS: A total of 83 patients were included, with a median age at onset of 52 (37-62) years and an unbalanced gender ratio (women 77.1%). Thirty-one patients had original systemic sarcoidosis in addition to ocular localisation, whereas 52 initially presented with isolated sarcoid uveitis...
July 2017: British Journal of Ophthalmology
Ashok Kumar, Anshul Goel, Mehul Lapsiwala
Polyarteritis nodosa is a medium artery vasculitis that can cause fatal complications. It commonly follows an acute monophasic course that may remit after treatment or cause serious morbidity or death. A 24-year-old patient described here had many vasculitic episodes in the past 16 years causing infarction of different organs. The last episode was most serious which caused mononeuritis multiplex, digital gangrene, bowel gangrene and subsequent perforations. There was strong clinical suspicion of this disease right from the beginning...
October 2016: Oxford Medical Case Reports
J M Pardal-Fernandez, S Ezsol-Lendvai, M Rodriguez-Vazquez, J L Agudo-Mena, B Godes-Medrano
INTRODUCTION: Leprosy is an infectious disease caused by the bacteria Mycobacterium leprae. It is particularly prone to affect the skin and the nerve trunks and, in fact, both are compromised in most infected patients. It is transmitted by exposure to those with the disease and sometimes by reactivation. One uncommon possibility is pure neural leprosy, which is characterised by neuropathy, but without skin lesions. We report the case of a patient with pure neural leprosy and review the diagnostic aspects...
September 16, 2016: Revista de Neurologia
Sukesh Edavalath, Abhra C Chowdhury, Sanat Phatak, Durga P Misra, Ritu Verma, Able Lawrence
Multiple myeloma can rarely mimic seronegative rheumatoid arthritis (RA). We report a 55-year-old woman who presented with longstanding deforming polyarthritis with extensive subcutaneous nodules, tenosynovitis, anti-cyclic citrullinated peptide positivity and mononeuritis multiplex. Even though the clinical picture was consistent with seropositive RA, the absence of bone erosion or joint space narrowing on hand and knee radiographs led us to question the diagnosis of RA. Further investigation revealed a diagnosis of multiple myeloma with cutaneous amyloid deposits, based on serum immunofixation, bone marrow aspiration and biopsy of a subcutaneous nodule...
August 12, 2016: International Journal of Rheumatic Diseases
Mari Kamiya, Peter Y Shane, Makoto Soejima, Shuji Tohda, Nobuyuki Miyasaka, Hitoshi Kohsaka
A 68-year-old man was admitted because of weakness of the left leg, dysesthesiae of the extremities and bilateral lower extremity purpura. A neurological examination showed mononeuritis multiplex with laboratory evidence of hypocomplementemia, cryoglobulinemia and leukocytoclastic vasculitis in the biopsy of a skin specimen. The patient also exhibited bilateral submandibular gland swelling, elevated serum IgG4 levels and infiltration of a large number of IgG4-positive plasma cells in the submandibular glands...
2016: Internal Medicine
Guan Wee Wong, Michael A Heneghan
For many patients with autoimmune hepatitis (AIH), the presence of extrahepatic features is well recognised both at the time of presentation and during long-term follow-up. Concomitant 'autoimmune disorders' have been described in 20-50% of patients with AIH, both in adults and children. Indeed, the presence of these associated phenomena has been incorporated into both the original and revised International AIH group scoring systems as an aid to codifying the diagnosis. In acute index presentations, non-specific joint pains sometimes flitting in nature have been reported in 10-60% of patients, and while joint swelling is uncommon, rheumatoid arthritis and mixed connective tissue disease have been reported in 2-4% of patients with AIH...
2015: Digestive Diseases
Masatoshi Takahashi, Fumiaki Katada, Susumu Sato, Hidehiro Shibayama, Toshio Fukutake, Shigeo Murayama
The patient was a 78-year-old man. Three years before admission, he developed transient peripheral neuropathy and purpura, and at admission, he presented with livedo reticularis of both his lower extremities and with mononeuritis multiplex. Vasculitis was not observed, and antiphospholipid antibodies were detected. The nerve and skin biopsies revealed no inflammation; axonal degeneration accompanied by thrombi was found in his arterioles and venules. Based on these findings, he was diagnosed with ischemic peripheral neuropathy due to primary antiphospholipid syndrome...
2015: Rinshō Shinkeigaku, Clinical Neurology
Ban-yu Saitoh, Shintaro Hayashi, Takashi Kamada, Hiroyuki Murai, Masatoshi Omoto, Jun-ichi Kira
A 45-year-old female with a history of dry eyes presented with chronic progressive disturbance of her right finger extension, bilateral foot drops, and dysesthesia in the left lower leg. On admission, neurological examination revealed decreased tendon reflex in the right upper limb and bilateral lower limbs, and dysesthesia in the distal outer portions of the bilateral lower legs. Her vibration sensation was moderately diminished in both lower legs. Weakness ranging from moderate to severe was predominantly found in the muscles innervated by the radial (r > l), medial (r > l), ulnar (r > l), deep peroneal (r ≒ l), tibial (r < l), and medial planter nerves (r < l)...
2015: Rinshō Shinkeigaku, Clinical Neurology
Jihye Park, Sun Im, Su-Jin Moon, Geun-Young Park, Yongjun Jang, Yeonjin Kim
Systemic vasculitis is a rare disease, and the diagnosis is very difficult when patient shows atypical symptoms. We experienced an unusual case of dysphagia caused by Churg-Strauss syndrome with lower cranial nerve involvement. A 74-year-old man, with a past history of sinusitis, asthma, and hearing deficiency, was admitted to our department for evaluation of dysphagia. He also complained of recurrent bleeding of nasal cavities and esophagus. Brain magnetic resonance imaging did not show definite abnormality, and electrophysiologic findings were suggestive of mononeuritis multiplex...
June 2015: Annals of Rehabilitation Medicine
D P Breen, J Deeb, S Vaidya, D N Lockwood, A Radunovic
Leprosy (or Hansen's disease) is a curable chronic infectious disease caused by the acid-fast bacillus Mycobacterium leprae. While leprosy remains one of the most common causes of neuropathy worldwide, its rarity in the UK means that many doctors are unfamiliar with the typical clinical features. This is problematic because early recognition and treatment is vital in order to minimise disease-related complications such as nerve injury. We describe a 75-year-old man who presented with multiple mononeuropathy (mononeuritis multiplex, particularly affecting the ulnar nerves) and typical granulomatous skin lesions, in whom the diagnosis was made on the basis of skin biopsy...
March 2015: Journal of the Royal College of Physicians of Edinburgh
Christina Fytili, Vassiliki Kalliopi Bournia, Chryssa Korkou, Georgios Pentazos, Alexander Kokkinos
Giant cell arteritis (GCA) has been previously associated with cranial mononeuritis (usually optic neuritis). We hereby describe a 68-year-old man who presented due to fever and diplopia of acute onset. Physical examination revealed left abducens nerve palsy and a hearing defect in the right ear. Brain imaging and cerebrospinal fluid analysis were not diagnostic. GCA was suspected, and treatment with high-dose methylprednisolone was initiated, leading to marked improvement. Temporal artery biopsy confirmed the presence of GCA...
April 2015: Rheumatology International
Claudio Sorino, Sergio Agati, Giuseppe Milani, Annarosa Maspero
We present a case of a 49-year-old man, with a 10-year history of bronchial asthma and nasal polyposis, who developed acutely painful paraplegia and paresthesias. Laboratory data showed elevated blood creatine kinase levels and myoglobinuria, which were diagnostic for rhabdomyolysis but only partially explained the neurological deficit. Electrophysiological studies revealed a sensorimotor neuropathy of multiple mononeuritis type. The patient also had leucocytosis with marked eosinophilia and antineutrophil cytoplasmic autoantibodies...
June 30, 2014: BMJ Case Reports
Hiroyuki Yamashita, Yuko Takahashi, Hiroshi Kaneko, Toshikazu Kano, Akio Mimori
We herein report the case of a 72-year-old woman with diffuse cutaneous systemic sclerosis (SSc) complicated by antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis who exhibited honeycomb lung without volume loss. On admission, chest computed tomography (CT) revealed honeycomb lung without volume loss in addition to increased density of the partition walls. A renal biopsy revealed global sclerosis and cellular crescent formation. Mononeuritis multiple subsequently occurred, and steroid pulse therapy with cyclophosphamide was administered...
2014: Internal Medicine
Takashi Iijima, Tatsuya Suwabe, Keiichi Sumida, Noriko Hayami, Rikako Hiramatsu, Eiko Hasegawa, Masayuki Yamanouchi, Junichi Hoshino, Naoki Sawa, Kenmei Takaichi, Kenichi Oohashi, Takeshi Fujii, Yoshifumi Ubara
We report a Japanese woman with systemic rheumatoid vasculitis (SRV) complicated by necrotizing crescentic glomerulonephritis (NCGN). Rheumatoid arthritis first occurred at the age of 19 years, followed by interstitial pneumonia, hepatitis, rheumatoid nodules, mononeuritis multiplex, and hypocomplementemia in chronological order. At the age of 51 years, rapidly progressive renal failure occurred with nephrotic proteinuria, and NCGN with subepithelial deposits was revealed by renal biopsy. Severe destructive changes of multiple joints and scleritis were detected, but anti-neutrophil cytoplasmic antibody was negative on enzyme-linked immunosorbent assays and indirect immunofluorescence...
January 2015: Modern Rheumatology
Lenaïg Le Clech, Marie Jeanne Rizcallah, Zarrin Alavi, Pascal Hutin
B-cell prolymphocytic leukaemia (BPLL) is a haematological malignancy defined as lymphocytosis and splenomegaly with >55% circulating cells being clonal prolymphocytes of B-cell origin. The evolution of this disease is more aggressive than chronic lymphocytic leukaemia. We reported a case of a 62-year-old man with BPLL who, on treatment, attained cytological, immunophenotypic and complete cytogenetic remission. He subsequently developed an asymmetric sensorimotor neurological disorder, suggestive of lymphomatous infiltration (neurolymphocytosis)...
September 2, 2013: BMJ Case Reports
Rafael Trinidad Hernandez, Hector Guerra-Garofalo, Ivonne Jimenez-Velazquez, Mark Vergara
SESSION TYPE: Miscellaneous Global Case Report PostersPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Rheumatoid arthritis has multiple affections that may include the lungs. The later are associated with disease stage and progression as well. In his report, we present the case of a male patient with long standing, veneer treated, rheumatoid arthritis presenting with a rather challenging pulmonary complication.CASE PRESENTATION: A 64 years old bedridden male was admitted to the hospital after 5 days of chills, shortness of breath and persistent cough with moderate yellow sputum and left base pleuritic pain...
October 1, 2012: Chest
Salvador de la Torre Carazo, Olga Tourin, Daniel Smith, Fischer Aryeh
SESSION TYPE: Miscellaneous Case Report Posters IIPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Lung disease occurs commonly in rheumatoid arthritis (RA) and is associated with significant morbidity and mortality. Recently, Fischer and colleagues demonstrated that anti-cyclic citrullinated peptide (anti-CCP) positive individuals with airways or interstitial lung disease may represent a "pre-articular" RA phenotype.CASE PRESENTATION: A 61-year-old Caucasian man, with a 7.5 pack-year smoking history, seasonal allergies, gastroesophageal reflux disease, obstructive sleep apnea, and dyslipidemia presented with pleuritic chest pain and dry cough of five months duration...
October 1, 2012: Chest
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