Vasculitic Neuropathies, its Varied Manifestations, and Associations

Abstract

Vasculitic neuropathies are disorders that result from inflammation in the peripheral nerve's vascular supply, resulting in ischemic injury. These disorders may be confined to peripheral nerves or may be a result of systemic inflammation. It is imperative that we recognize these disorders early to prevent morbidity and mortality. Hereby, we describe three cases of vasculitic neuropathy with varied presentations and their outcomes with treatment. A 43-year-old male presented with burning paresthesia of 4-month duration along with facial nerve paresis and black discoloration of toes of lower limbs. On evaluation, he had features of facial palsy along with dry gangrene involving the toes and calf region. A 36-year-old woman presented with features of paresthesia of lower limbs with reduced perception of temperature and distal and proximal muscle weakness. A 49-year-old male presented with features of multisystem involvement including lower respiratory tract infection and gastrointestinal symptoms along with distal and proximal muscle weakness. Nerve, muscle, and skin biopsies in all these three cases confirmed the diagnosis of vasculitic neuropathy. The first two patients were treated with methylprednisolone and cyclophosphamide and showed very good improvement during follow-up. However, the third patient was unwilling to receive treatment. Vasculitic neuropathies present with varied presentations. Therefore, when evaluating patients with peripheral neuropathy, suspicion of vasculitic etiology should be heightened. Timely diagnosis is very important in the management of vasculitic neuropathy and also for a better outcome. It is also important to acknowledge that nerve biopsy is a confirmatory investigation and should be performed in cases of strong suspicion.