| 제목 |
Mononeuritis multiplex misdiagnosed as Lumbosacral Radiculopathy |
| 소속 |
Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Department of Rehabilitation Medicine1 |
| 저자 |
Yun jeong Jang1*, Chang Han Lee1, Min Kyun Oh1, Eun Shin Lee1, Hee Suk Shin1, Chul Ho Yoon1† |
Introduction
Vasculitis means damage to the blood vessel wall due to the infiltration of inflammatory cells. Clinical symptoms are associated with ischemic injury to the organ receiving blood supply by damaged blood vessels. Peripheral nervous system involvement is common in systemic vasculitis and is sometimes the first symptom of systemic vasculitis. Vasculitic neuropathy manifests in form of mononeuritis multiplex but in some patients it may occur in form of symmetric sensory motor neuropathy involving the distal part. We report a case of mononeuritis multiplex that was misdiagnosed as lumbosacral radiculopathy in a patient with rheumatoid arthritis.
Case presentation
In this case report, a 71-year-old female patient presented with severe back pain, symmetrical distal lower limb weakness and sensory abnormalities in her distal lower limbs for 2 months. Initially this was thought to be the result of lumbar radiculopathy or peripheral polyneuropathy. Electrodiagnosis was performed and then diagnosed as lumbosacral radiculopathy and peripheral polyneuropathy (Table 1). After about 10 to 14 days, motor weakness and sensory loss in the lower extremities worsened, accompanied with severe pain. Mononeuritis multiplex was diagnosed on a follow – up electrodiagnosis (Table 2). The evidence of progressive peripheral polyneuropathy over the distal limbs was observed compared with the previous study. The nerves that were involved were both the tibial, common peroneal, median and ulnar nerves. Thereafter, the patient was transferred to rheumatology department for treatment on the vasculitis and mononeuritis multiplex. Steroid pulse therapy was attempted, however, due to large amount of rectal bleeding after the first session, the treatment was not completed. After 10 months, the patient still had symptoms of distal limb weakness and sensory loss but the severity of the pain was greatly reduced.
Conclusion
Patients in the early stages of vasculitic neuropathy may present with features of lumbosacral radiculopathy. The diagnosis of vasculitic neuropathy can be made through continuous checks on the progress of the symptoms occurring within a short period of time and by conducitng serial electrodiagnosis. In the case of this patient, prognosis would be good if early treatment was possible with rapid diagnosis. Proper early diagnosis enables early treatment and reduces complications and mortality. |
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Table 1. Initial Findings of Nerve Conduction Studies and Needle Electromyography
Table 2. Follow up Findings of Nerve Conduction Studies and Needle Electromyography
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