Sensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with Polyangiitis
Granulomatosis with polyangiitis (GPA) typically presents with upper or lower respiratory tract symptoms and/or with renal involvement. Although it can affect the peripheral nervous system frequently, with mononeuritis multiplex being the most common pattern, the occurrence of peripheral sensory-mot...
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| Format: | Article |
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Wiley
2021-01-01
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| Series: | Case Reports in Rheumatology |
| Online Access: | http://dx.doi.org/10.1155/2021/5353575 |
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| author | Wasundara Wathurapatha B. G. A. Rathnamali Upul Dissanayake |
| author_facet | Wasundara Wathurapatha B. G. A. Rathnamali Upul Dissanayake |
| author_sort | Wasundara Wathurapatha |
| collection | DOAJ |
| description | Granulomatosis with polyangiitis (GPA) typically presents with upper or lower respiratory tract symptoms and/or with renal involvement. Although it can affect the peripheral nervous system frequently, with mononeuritis multiplex being the most common pattern, the occurrence of peripheral sensory-motor polyneuropathy as a presenting manifestation is distinctly rare. Prevalence of digital gangrene is also extremely rare in GPA. We describe a 46-year-old woman presenting with severe peripheral sensorimotor polyneuropathy affecting bilateral lower limbs preceded by a purpuric skin rash and multiple painful ulcers confined to the lower limbs. She had evidence of digital ischemia affecting multiple toes and dry gangrene of the left 4th toe. Diagnosis of GPA was made based on skin biopsy, positive ANCA serology, and clinical criteria. She made a good recovery following aggressive immunosuppressive treatment with methylprednisolone and cyclophosphamide and was maintained on prednisolone and azathioprine. This case highlights the importance of suspecting GPA in a patient presenting with sensorimotor polyneuropathy and/or digital ischemia even in the absence of more classic presenting features and underlies the necessity of accurate differential diagnosis in evaluating a case of peripheral neuropathy. |
| format | Article |
| id | doaj-art-6b412d3522854d0f8e18ddb795541777 |
| institution | Kabale University |
| issn | 2090-6897 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Rheumatology |
| spelling | doaj-art-6b412d3522854d0f8e18ddb7955417772025-02-03T06:06:31ZengWileyCase Reports in Rheumatology2090-68972021-01-01202110.1155/2021/5353575Sensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with PolyangiitisWasundara Wathurapatha0B. G. A. Rathnamali1Upul Dissanayake2National Hospital of Sri LankaNational Hospital of Sri LankaNational Hospital of Sri LankaGranulomatosis with polyangiitis (GPA) typically presents with upper or lower respiratory tract symptoms and/or with renal involvement. Although it can affect the peripheral nervous system frequently, with mononeuritis multiplex being the most common pattern, the occurrence of peripheral sensory-motor polyneuropathy as a presenting manifestation is distinctly rare. Prevalence of digital gangrene is also extremely rare in GPA. We describe a 46-year-old woman presenting with severe peripheral sensorimotor polyneuropathy affecting bilateral lower limbs preceded by a purpuric skin rash and multiple painful ulcers confined to the lower limbs. She had evidence of digital ischemia affecting multiple toes and dry gangrene of the left 4th toe. Diagnosis of GPA was made based on skin biopsy, positive ANCA serology, and clinical criteria. She made a good recovery following aggressive immunosuppressive treatment with methylprednisolone and cyclophosphamide and was maintained on prednisolone and azathioprine. This case highlights the importance of suspecting GPA in a patient presenting with sensorimotor polyneuropathy and/or digital ischemia even in the absence of more classic presenting features and underlies the necessity of accurate differential diagnosis in evaluating a case of peripheral neuropathy.http://dx.doi.org/10.1155/2021/5353575 |
| spellingShingle | Wasundara Wathurapatha B. G. A. Rathnamali Upul Dissanayake Sensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with Polyangiitis Case Reports in Rheumatology |
| title | Sensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with Polyangiitis |
| title_full | Sensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with Polyangiitis |
| title_fullStr | Sensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with Polyangiitis |
| title_full_unstemmed | Sensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with Polyangiitis |
| title_short | Sensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with Polyangiitis |
| title_sort | sensory motor polyneuropathy and digital ischemia a rare presentation of granulomatosis with polyangiitis |
| url | http://dx.doi.org/10.1155/2021/5353575 |
| work_keys_str_mv | AT wasundarawathurapatha sensorymotorpolyneuropathyanddigitalischemiaararepresentationofgranulomatosiswithpolyangiitis AT bgarathnamali sensorymotorpolyneuropathyanddigitalischemiaararepresentationofgranulomatosiswithpolyangiitis AT upuldissanayake sensorymotorpolyneuropathyanddigitalischemiaararepresentationofgranulomatosiswithpolyangiitis |