Cryoglobulinemic Vasculitic Mononeuritis Multiplex in a Teenager

Abstract

We present a 16-year-old girl with chronic distal purpura and mild intellectual disability of undetermined etiology. She developed subacute distal limb pain and ulcerations followed by acute asymmetric hand weakness and numbness. She was hospitalized for a rash exacerbation, uncontrolled pain, and concerns for a drug reaction related to neuropsychiatric medications, oxcarbazepine, and guanfacine. Initial evaluation revealed weakness of bilateral wrist flexors (left dominant), bilateral finger extensors (mild), bilateral first dorsal interosseous and abductor digiti minimi (severe), and left deep finger flexors and abductor pollicis brevis (severe). There was left-hand large fiber sensory loss in the medial palmar and dorsomedial aspects. There was no weakness or sensory loss in her legs. Deep tendon reflexes were unobtainable except at the Achilles tendons bilaterally. Cranial nerves were intact, and mental status was consistent with her pre-existing intellectual disability and impulsivity.