Partial Improvement Research Articles

Biochemical and histological study of spermatogenic activity in male albino rats treated with Cantharis Q

Cantharidin is a bioactive toxin produced by the blister beetles commonly called Spanish fly. This natural compound is a bicyclic monoterpene (C10H12O4 ) that has clinical application as an anti-inflammatory, antiviral as well as antitumor agent and has been widely used to treat a variety of skin-related diseases. There are several reports of consumption of dried blister beetles and their traditional formulations due to a long history of the supposed aphrodisiac property of cantharidin. The present study, therefore, aimed at investigating the biochemical and histological changes in the testes of male albino rats of Wistar strain due to oral intake of Cantharis Q, a crude alcoholic extract of blister beetle Lytta vesicatoria used as mother tincture and as diluted potentized form in homeopathy. The experimental rats were given Cantharis Q dosage of 500 µg/Kg body weight for 60 days and the subsequent autorecovery was also studied after 30 days without treatment. The treated rats showed a significant decrease in the weight of testis, seminiferous tubular diameter and sperm count. Activity of testicular acid phosphatase (ACP), alkaline phosphatase (ALP), hyaluronidase (HL) enzyme and content of cholesterol, total protein, DNA and RNA decreased significantly whereas activity of beta-glucuronidase (BG) enzyme and glycogen was significantly increased. Spermatogenesis stages VIII, IX and X showed sloughing of round spermatids into the tubular lumen. The animals kept for autorecovery showed only partial improvement. Thus, it could be concluded that the treatment had a negative impact on the physiological function of testis of albino rat causing detrimental effects on the spermatogenic activity

Paradoxical exacerbation of sclerouveitis following Rituximab infusion.

To report on an unexpected side effect of Rituximab (RTX), a B-cell targeting monoclonal agent, in a patient with severe sclerouveitis, leading to severe visual loss. Observational case report. A 61-year-old female was treated with RTX for a severe sclerouveitis occurring with granulomatosis with polyangiitis. Initially it responded partly to high dose of oral corticosteroids, however, her sclerouveitis recurred after two months during tapering below 20mg daily. The days following the RTX infusions, aggravation of the intraocular inflammation was seen, endangering visual acuity. No evidence for an infection or other cause were found. High doses of oral corticosteroids were started within one week, where after the ocular inflammation resolved. For persisting hypotony and chorioretinal detachment a combined pars plana vitrectomy with phacoemulsification and silicone oil tamponade was performed. The retina remained attached under oil tamponade with partial improvement of the BCVA to finger counting. Ophthalmologist should be aware of the possibility of this paradoxical local reaction to RTX infusion, particularly in bilateral and/or severe cases, which carry a risk of a poor outcome.

Long-term benefit of DAAs on gut dysbiosis and microbial translocation in HCV-infected patients with and without HIV coinfection

Long-term effect of Direct-acting antivirals (DAAs) on gut microbiota, short-chain fatty acids (SCFAs) and microbial translocation in patients with hepatitis C virus (HCV) infection who achieve sustained virological response (SVR) were limited. A longitudinal study of 50 patients with HCV monoinfection and 19 patients with HCV/HIV coinfection received DAAs were conducted. Fecal specimens collected at baseline and at week 72 after treatment completion (FUw72) were analyzed for 16S rRNA sequencing and the butyryl-CoA:acetateCoA transferase (BCoAT) gene expression using real-time PCR. Plasma lipopolysaccharide binding protein (LBP) and intestinal fatty acid binding protein (I-FABP) were quantified by ELISA assays. SVR rates in mono- and coinfected patients were comparable (94% vs. 100%). The improvement of gut dysbiosis and microbial translocation was found in responders but was not in non-responders. Among responders, significant restoration of alpha-diversity, BCoAT and LBP were observed in HCV patients with low-grade fibrosis (F0–F1), while HCV/HIV patients exhibited partial improvement at FUw72. I-FABP did not decline significantly in responders. Treatment induced microbiota changes with increasing abundance of SCFAs-producing bacteria, including Blautia, Fusicatenibacter, Subdoligranulum and Bifidobacterium. In conclusion, long-term effect of DAAs impacted the restoration of gut dysbiosis and microbial translocation. However, early initiation of DAAs required for an alteration of gut microbiota, enhanced SCFAs-producing bacteria, and could reduce HCV-related complications.

Extreme lateral infracondylar approach for internal jugular vein compression syndrome: A case series with preliminary clinical outcomes.

Internal jugular vein (IJV) stenosis is associated with several neurological disorders including idiopathic intracranial hypertension (IIH) and pulsatile tinnitus. In cases of extreme bony compression causing stenosis in the infracondylar region, surgical decompression might be necessary. We aim to examine the safety and efficacy of surgical IJV decompression. We retrospectively reviewed patients who received surgical IJV decompression via the extreme lateral infracondylar (ELI) approach between July 2020 and February 2022. Fourteen patients with IJV stenosis were identified, all with persistent headache and/or tinnitus. Six patients were diagnosed with IIH, three of whom failed previous treatment. Of the eight remaining patients, two failed previous treatment. All underwent surgical IJV decompression via styloidectomy, release of soft tissue, and removal of the C1 transverse process (TP). Follow-up imaging showed significant improvement of IJV stenosis in eleven patients and mild improvement in three. Eight patients had significant improvement in their presenting symptoms, and three had partial improvement. Two patients received IJV stenting after a lack of initial improvement. Two patients experienced cranial nerve paresis, and one developed a superficial wound infection. The ELI approach for IJV decompression appears to be safe for patients who are not ideal endovascular candidates due to bony anatomy. Confirming long-term efficacy in relieving debilitating clinical symptoms requires longer follow-up and a larger patient cohort. Carefully selected patients with symptomatic bony IJV compression for whom there are no effective medical or endovascular options may benefit from surgical IJV decompression.

Results of subinguinal microsurgical varicocelectomy

The subinguinal microsurgical varicocelectomy is considered as the gold standard surgical technique for the treatment of varicocele. The objective of this study is to evaluate the results of this technique on the resolution of pain and the parameters of sperm analysis. Single-center, retrospective study that includes 22 patients who have been operated over a period of six months for a clinically palpable varicocele via the microsurgical subinguinal technique. Nine patients were operated for pain and 13 patients for infertility with an abnormality of their sperm analysis. All the patients operated for pain had a complete resolution of pain at the postoperative follow-up (3 months). Concerning the patients operated for infertility, 76.92% of the patients had a normal sperm analysis, 7.69% of the patients presented a partial improvement, and 15.39% of the patients without any improvement. Analysis of sperm's parameters at 3 months showed a significant improvement in the morphology (4.3% vs 6.69% of typical forms according to Kruger; P<0.05) and mobility (progressive mobility 15.6% vs 23% postoperatively; P<0.01). A non-significant improvement (low sample) in the concentration was noted (21.58 million/mL preoperative vs 34.9 million/mL postoperative, P=0.08). Pregnancies are noted in 38.5% of patients. A postoperative complication was noted with surgical site infection resolved with antibiotics. This single-center study confirms that the treatment of varicocele by subinguinal microsurgical route is an effective therapeutic strategy on symptomatic varicocele and in infertile men. This technique is associated with few complications.

703 Parsonage Turner Syndrome After COVID-19 Vaccination – a Systematic Review

Abstract Aim Parsonage Turner Syndrome (PTS) is a rare acute neuritis usually reported after an antecedent event like surgery, infection, trauma, medication or immunisation. PTS presents as sudden, often unilateral, severe shoulder pain with progressive weakness and altered neurology. The global mass COVID vaccine program has resulted in increased reporting of post-vaccine PTS. The aim of this review is to report the outcomes of PTS after COVID-19 vaccination. Method A systematic review was conducted according to the PRISMA statement. An electronic search was performed on Medline, PubMed, Embase and CINAHL databases using the keywords ‘COVID-19’, ‘Coronavirus’, ‘Parsonage Turner Syndrome’, ‘Brachial neuritis’, ‘Neuralgic Amyotrophy’, ‘Vaccine’, ‘Immunisation’ and ‘Shoulder’. Results 16 articles with a total of 35 patients, 24 males and 11 females, were reviewed. The mean age was 52 years. The median time to develop symptoms was 7 days, with 69% patients reporting ipsilateral symptoms to the vaccinated arm. 91% patients presented with sensory and motor symptoms. MRI scan was normal in 26% while denervation muscle oedema was present in 20%. 37% patients were treated with physiotherapy and rest, while 63% received steroid therapy. 23% showed no improvement while 69% showed partial or complete improvement. The mean follow-up time was 3 months (range one week to six months). Conclusions PTS is a rare complication described with vaccines like influenza, tetanus and hepatitis. PTS is also associated with the COVID vaccine. The limited reports suggest the treatment and recovery are consistent with that for other aetiology. This complication is not a reason to avoid the COVID vaccine.

Prominent mitochondrial pathology in a case of refractory dermatomyositis: coincidence or concause?

Mitochondrial alterations are a common finding in muscle biopsy of sporadic inclusion body myositis (s-IBM) and polymyositis with mitochondrial pathology (PM-Mito). Both disorders generally have poor treatment response. Nevertheless, mitochondrial myopathology has been rarely reported in dermatomyositis (DM) outside areas of perifascicular atrophy and a relationship with therapeutic outcome is not established. We report on clinical, immunological, radiological, and myopathological findings of a case of severe, treatment-refractory anti-Mi-2-positive DM. A 77-year-old woman developed anti-Mi-2 DM with severe diffuse muscle weakness associated with abundant mitochondrial abnormalities at muscle biopsy, beside the typical features of inflammatory myopathy. The patient was poorly responsive to multiple-line therapies and finally anti-JAK (anti-Janus activated kinase) was administered, leading to partial clinical improvement. Given the usual satisfactory treatment response and favorable outcome of anti-Mi-2 DM, we suppose that mitochondrial dysfunction on muscle biopsy could represent a marker of disease severity in DM, predicting a worse response to treatment and a poor clinical outcome. JAK-inhibitors could represent a good treatment option in refractory anti-Mi-2 DM with mitochondrial abnormalities.

Assessment of reproductive toxicity of gold nanoparticles and its reversibility in male albino rats

Nanotechnology has become a trending area in science all over the world. Although gold nanoparticles (AuNPs) have been utilized widely in biomedical fields, potential toxicities may arise from their interactions with biological systems. The current study aimed at evaluating the toxic effects of AuNPs on the reproductive system of adult male albino rats and assessing the recovery probability. In this study, AuNPs (13 ± 4 nm in diameter) were synthesized, and the experimental work was conducted on 60 adult male albino rats divided into the following groups: control group (received deionized water daily intraperitoneally (IP) for 28 days), test group, and withdrawal groups I and II (received 570 μg/kg of 13 ± 4 nm AuNPs daily IP for 28 days). Withdrawal groups I and II were left for another 30 and 60 days without sacrification, respectively. The test group showed significant decreases in final body and absolute testicular weights, testosterone hormone level, sperm count and motility, and spermatogenesis score, as well as significant increase in the percentage of sperms of abnormal morphology compared to the control group, associated with significant light and electron microscopic histopathological changes. Partial improvement of all studied reproductive parameters was detected after one month of withdrawal in withdrawal group I, and significant improvement and reversibility of all these parameters were reported after two months of withdrawal in withdrawal group II. So, AuNPs induce male reproductive toxicity, which partially improves after one month of withdrawal and significantly improves and reverses after two months of withdrawal.

When the adrenals alert us to a systemic fungal disease.

We present a patient referred for investigation of adrenal insufficiency, confirmed due to disseminated paracoccidioidomycosis (PCM), with abdominal and central nervous system (CNS) involvement. Establishing the pathogenesis and immunological processes involved in chronic or latent infections by PCM has been challenging. Medical doctors caring for patients with immunodeficiencies should learn about these fungal infections to properly guide travel planning and have this possibility in the diagnostic arsenal when the patient returns from endemic areas. After 13 months of treatment, the patient showed good clinical evolution, and we repeated imaging exams, showing partial improvement of the preview lesions. Diagnosis and treatment can prevent catastrophic events.

Perceptions of Autism Spectrum Disorder among People in a Remote Area of Bangladesh

Introduction: Autism is a neurodevelopmental disorder which are manifested within two years of life. It exhibits difficulties in social interaction, verbal and nonverbal communication, as well as repetitive or constrained interests and actions. Autism has already posed significant burden in health sector in Bangladesh. That’s why it is high time to address autism. Objectives: To assess the factors affecting children with ASD and perception of rural people about it. Methods: This cross sectional study was carried out from 01 January to 31 December, 2021 among 55 people of different unions of Bauphal Upazila of Patuakhali district. Results: Majority of the autistic children are male (61.82%). In maximum cases, parents and family members were usually the first persons to identify (60%) the autistic symptoms. A good percentage (21.82%) respondents were ignorant about the cause of autism. Most (38.18%) of the children with autism were treated at government hospital. Maximum therapy received by the children is speech therapy (41.82%) and there is partial improvement (54.55%) of autism by applying therapy. Conclusion: This study revealed that most of the parents of autistic child were unaware about its contributory factors and treatment. Even there is scarcity of trained or specialist health professionals. There are also false belief about autism that inhibit people to take proper treatment. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 66-71

Intralesional measles, mumps, and rubella vaccine after failure of intralesional Candida antigen for the treatment of recalcitrant pediatric warts.

Numerous studies have investigated the efficacy of intralesional immunotherapy for warts, but there are a lack of studies investigating the efficacy of alternative intralesional immunotherapies following failure of initial intralesional immunotherapy. In this retrospective study, we aimed to investigate the efficacy of intralesional measles, mumps, and rubella vaccine for the treatment of pediatric warts following failure of intralesional therapy with Candida antigen. Following intralesional measles, mumps, and rubella vaccine administration, 8/51 (15.5%) patients had complete resolution of their warts, 6/51 (12%) had near complete resolution, 19/51 (37%) had partial improvement, 12/51 (23.5%) had no change, and 6/51 (12%) had worsening. Although limited by retrospective nature and low sample size, our results demonstrate that intralesional immunotherapy with measles, mumps, and rubella vaccine provides an alternative therapeutic option for the treatment of recalcitrant pediatric warts in patients who fail to respond to intralesional Candida antigen.

EFFECT OF THE ASSOCIATION OF AMANTADINE AND QUETIAPINE IN THE TREATMENT OF REM SLEEP BEHAVIOR DISORDER: CASE REPORT

The aim was to report the case of a patient with REM sleep behavior disorder, unresponsive to standard treatment and with complete control of the condition after association of amantadine. Female patient, 45 years old, with systemic arterial hypertension and hypothyroidism, referred to neurological care, reporting frequent episodes of nocturnal agitation in the first hours of sleep, with walking and vocalization, waking up easily if called. She complains of drowsiness and anxiety, secondary to the impact of the RBD on her personal life. She mentions previous attempts at drug treatment with benzodiazepines (Bromazepam and Clonazepam), Zolpidem and Trazodone, all without clinical improvement, with Quetiapine being introduced at a low dose (not yet tried) 25mg, with a therapeutic target of 50mg with partial improvement only with 25mg. When trying 50mg, presenting a worsening of the picture. In a new follow-up, therapy with Amantadine 50 mg/day associated with Quetiapine 25 mg/day was started. The patient returned reporting a significant improvement in the condition, less frequent episodes associated with reduced nocturnal movement. After adaptation of the combined therapy, with adjustments in the dose of Amantadine, an increase of 50mg every 14 days up to 200 mg/day, with the possibility of using quetiapine 50mg (balance between the drugs), the patient evolved stable, with a great improvement in the quality of life and absence of new episodes of the sleep disorder.

Assessment of Anxiety, Depression, and Sleep Quality in Mothers of Children with Atopic Dermatitis: A Qualitative Questionnaire Study.

To compare the anxiety, depression and sleep quality of mothers of healthy control children and mothers of children with atopic dermatitis (AD) of varying severity, both before and after treatment. A total of 120 parent-child dyads participated in the study. These dyads were divided into four subgroups of 30 patients each: mild AD, moderate AD, severe AD, and control groups. The children's symptoms, their mothers' psychological status, and their mothers' sleep quality were evaluated using the Scoring of Atopic Dermatitis (SCORAD), the Hospital Anxiety and Depression Scale (HADS), and the Pittsburgh Sleep Quality Index (PSQI), respectively, before and after a one-month comprehensive treatment. SCORAD, representing differences in severity of children's AD, decreased significantly after one month's treatment (p < 0.001). Anxiety in mothers significantly decreased in all AD severity groups after treatment (p < 0.05). However, for depression, only the mothers in the mild and moderate AD groups showed a decrease after treatment (p < 0.05). The PSQI total score also decreased in the mild AD group after treatment (p < 0.05). The most severe effect was seen in the psychology and sleep quality of mothers of children with severe AD. After one month of treatment, the psychological health and sleep quality of the mothers in the mild AD group significantly improved, while those of mothers in the moderate and severe AD groups showed partial improvement.

Hepatorenal syndrome: Updates.

Hepatorenal syndrome: Updates.

Safety of Antibiotic Irrigations for Acute Exacerbations of Chronic Rhinosinusitis in Patients with Identical Drug Allergies or Adverse Reactions: A Pilot Study.

Objectives: The use of topical antibiotics in the treatment of acute exacerbation of chronic rhinosinusitis (AECRS) represents a viable option prior to initiation of parenteral antibiotics when no oral antibiotic alternatives are available due to patient allergy or adverse reactions. The main objectives of this pilot study were to determine the safety and efficacy of antibiotic irrigations in the treatment of AECRS in patients with documented adverse reactions to the oral form of the drug. Methods: A retrospective review was performed of patients diagnosed with AECRS treated with antibiotic irrigations. Inclusion criteria included a documented allergy or adverse event to the systemic form of the same antibiotic. Patient demographics, medical history, prior sinus surgery, nasal endoscopy findings, and microbiology results were obtained. Side effects to the antibiotic irrigations were recorded. Results: Six patients met the inclusion criteria resulting in 7 treated cases of AECRS. Four patients with adverse effects to oral trimethoprim/sulfamethoxazole (TMP/SMZ) received TMP/SMZ irrigations, and 1 patient with an adverse reaction to oral ciprofloxacin was treated with ciprofloxacin irrigations. One patient with adverse effects to both oral TMP/SMZ and levofloxacin was treated with TMP/SMZ and levofloxacin irrigations, respectively during 2 separate AECRS episodes. Following treatment, 1 case (14.3%) resulted in complete resolution of infection, 1 (14.3%) had partial improvement, and 5 (71.4%) had minimal to no endoscopic improvement at the subsequent clinic visit. There were no adverse reactions to antibiotic irrigations among the entire cohort. Conclusions: Currently, no prior study has examined whether adverse reactions to a systemic antibiotic also occur when the medication is delivered topically via sinonasal irrigations. Our findings suggest that topical administration of antibiotics may be a safe alternative for patients with adverse effects to the systemic form.

Endoscopic Endonasal Transplanum-Transtuberculum Approach for Pituitary Adenomas/PitNET: 25 Years of Experience.

The role of the endoscopic transplanum-transtuberculum approach (ETTA) in the treatment of pituitary adenomas/PitNETs (PAs) is sparsely analyzed in the literature, and its use is still debated in the current practice. The aim of this study was to report our experience with this approach. Our institutional registry was retrospectively reviewed, and patients who underwent ETTA for a PA from 1998 to 2022 were included. Fifty-seven cases were enrolled over a time span of 25 years, corresponding to 2.4% of our entire PA caseload. Radical resection was achieved in 57.9% of cases, with re-do surgery (p = 0.033) and vessel encasement/engulfment (p < 0.001) as predictors of partial resection. CSF leak incidence stood at 8.8%, with higher BMI (p = 0.038) as its only significant predictor. Partial or full improvement of the visual field deficits was achieved in 73.5% of cases. No surgical mortality was observed. According to our results, ETTA for the treatment of PAs is characterized by a satisfactory surgical outcome but with greater morbidity than the conventional endoscopic approach. Therefore, it should be reserved for the few selected cases otherwise unsuitable for the endoscopic trans-sphenoidal route, representing a valid alternative and an effective complementary route for the transcranial approach for these challenging PAs.

Causes and outcomes of revision surgery in subjects with pulsatile tinnitus.

Once the underlying pathology has been identified, pulsatile tinnitus (PT) can be treated successfully with surgical or interventional management. However, some patients experience residual or recurrent symptoms following initially successful surgical treatment, and require revision surgery or additional procedures. Here, we report a case series of patients who had undergone revision surgery or interventional treatment, and suggest possible ways of minimizing the need for revision. Between January 2014 and March 2023, a total of seven subjects underwent revision surgery or interventional treatment for persistent or recurrent PT after initial surgical treatment. Demographic data, reasons for revision, and changes in symptoms before and after revision were analyzed retrospectively. Temporal bone computed tomographic angiography images were reviewed to identify the causes and reasons for revision. Of the seven subjects, six underwent sigmoid sinus (SS) resurfacing/reshaping due to ipsilateral diverticulum (Div) or dehiscence (Deh), and one underwent jugular bulb (JB) resurfacing due to a high-riding JB with bony Deh. Of the five subjects who underwent revision SS surgery due to recurrent SS-Div or SS-Deh, three showed marked resolution of PT, while the other two showed partial improvement of the symptoms. One subject who underwent revision JB resurfacing, and another who underwent additional transarterial embolization for a concurrent ipsilateral dural arteriovenous fistula, reported marked improvement of PT. The possibility of recurrence should be taken into account when performing surgical intervention in patients with PT. The likelihood of recurrence can be minimized through a comprehensive evaluation to identify possible multiple etiologies, and through the use of durable materials and appropriate surgical methods.

Dide Botcazo Syndrome: An Atypical and Rare Presentation of Stroke

Dide-Botcazo syndrome is a very rare condition resulting from bilateral posterior cerebral infarction. The clinical presentation is atypical of cerebral infarction and is characterized by the association of cortical blindness and anosognosia associated with amnesia and topographical disorientation. We report the clinical case of a 65-year-old man consulting for confusion associated with amnesia, cortical blindness and right hemiparesis evolving for one week. The CT scan showed hypodensity in the territory of the bilateral posterior cerebral arteries. The scan also ruled out malformations such as aneurysms or cerebral masses, as well as hemorrhagic stroke. The patient was treated with antiplatelet drugs and early rehabilitation. Progression was marked by partial improvement in motor disorders and confusion. Cortical blindness and anosognosia were permanent.

The Use of Sphinkeeper® In Faecal Incontinence

Introduction: Faecal Incontinence is a condition that can affect up to 20% of population during their lifetime with female predominance. Sacral Nerve Stimulation (SNS) has been recently shown to have significant benefits in mainly urge incontinence but this has left a large group of patients with passive incontinence without effective management options. The SphinKeeper® (SK) allows treatment of more sizeable defects in the internal or external anal sphincter. Preliminary series have shown some benefit of the procedure in treatment of faecal incontinence. Methods: A single-centre retrospective observational study of SphinKeeper® prostheses was conducted at St Helens and Knowsley NHS trust and we believe this to be one of the largest series of SphinKeeper® in the UK. SphinKeeper® restores sphincter function by using placement of self-expanding prostheses into the inter-sphincteric space. The operation involves implantation of 10 self-expanding sterile prostheses between the internal and the external sphincter, thus creating a third ring around the circumference of the anal canal. Results: Most patients were ASA 2 (n=10). 43% (6/14) patients had previous colorectal surgery – THD and mucopexy (n=3), anorectal fistula surgery (n=1), anterior resection of rectum (n=1) and pelvic floor repair (n=1). EUS was carried out in 6 patients and in all 6 cases identified internal or external anal sphincter defect (IAS n=1, EAS n=3, IAS and EAS n=2). No patient sustained intraoperative complications. 2 patients reattended within 48 hours post op due to severe post-operative pain and were discharged with analgesia. Subjective results were evaluated using Vaizey and Wexner scores and showed significant improvement 4/14 patients, partial improvement in 7/14 patients and no improvement in 3/14 patients. Discussion: Our study evaluated the short-term outcomes of the procedure in 14 patients who had SphinKeeper® surgery between May 2017 and August 2020. Patients who took part in our study had previous treatment for faecal incontinence by a variety of methods (both medical and surgical) and suffered from different types of FI (passive, urge, mixed, associated urinary incontinence). It was promising to see there was a clinically significant improvement in continence indicated by a decrease in Vaizey and Wexner scores (p=0.00377 and p=0.00334 respectively (Wilcoxon test)) with 11 patients improving in scores. It is reasonable to consider Sphinkeeper™ as a safe and minimally invasive surgical intervention to achieve some degree of positive improvement for patients suffering from faecal incontinence.

Small fiber neuropathy associated with ANCA positivity: a case series and brief literature review.

Small fiber neuropathy [SFN] is a common peripheral neurologic disorder with a vast array of implicated etiologies. It has previously been proposed that some forms of immune-mediated small fiber neuropathy are driven by vasculitis, though antinuclear cytoplasmic antibodies [ANCA] antibodies have not commonly been reported in association with SFN, thus far. We present this case series to discuss the observation of a possible novel association between ANCA and SFN. This is a retrospective case series of 6 patients with SFN and ANCA positivity, with and without systemic manifestations. Patients included were diagnosed with SFN by skin biopsy or autonomic function testing and were seropositive for ANCA by ELISA. Six patients are outlined, including 4 females and 2 males. Antigen specific antibodies were MPO alone in 4 cases, PR3 alone in 1 case and both MPO and PR3 in 1 case. Systemic vasculitis was noted in 2 patients. Five patients received immunosuppression. Three patients experienced partial improvement, while symptoms stabilized in 3 patients. This is the first series of patients with suspected immune-mediated SFN and ANCA antibody positivity, raising the possibility of ANCA mediated isolated SFN. This is in contradistinction to the more typical ANCA-mediated peripheral neuropathy manifestations of mononeuropathy multiplex or axonal sensorimotor neuropathy. We cannot unequivocally prove ANCA-associated vasculitis [AAV] causality in these cases; however, the stabilization in SFN symptomatology and associated improvement in ANCA antibody titer, after AAV treatment, may be indicative of an association.