Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 39

Abstract

A 40‐year‐old smoker complained of pain, deep and burning in character, constant, and persistent, associated with paresthesias in his feet for a period of two years. Furthermore, he developed aching non‐traumatic foot ulcers. There was no history of diabetes and systemic illness. Neurological examination revealed loss of all modalities of sensation and hyperhidrosis in the limbs with a prominent distal‐to‐proximal gradient. The following laboratory tests were normal: blood count; test for liver, kidney, and thyroid function; cryoglobulins; anti‐HCV antibodies and HIV. Neurophysiological investigation revealed an axonal neuropathy with a distal‐to‐proximal distribution in the limbs. Sural nerve biopsy showed a severe chronic axonal neuropathy. Prominent thickening of endoneurial microvessel endothelial cells was present with narrowing of lumen. Congo Red staining was negative. He initiated treatment with alprostadil alfa‐ciclodestrina and stopped smoking. The patient reported prompt improvement of neurologic symptoms as well as skin abnormalities few months after the begin of therapy. Ischemic neuropathy in which nerve damage occurs in the more distal portion of the limbs has been reported. In our patient, clinical presentation, neurophysiological and neuropathological findings suggest the diagnosis of a Lower Extremity Ischemic Neuropathy probably triggered by smoke.