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Washington University Experience | PERIPHERAL NEUROPATHY | 11 VASCULITIS - VASCULOPATHY | 2 Vasculopathy | 1A0 Case 1 History
Case 1 History ---- The patient is a 52-year-old woman who presented with right-sided leg numbness and weakness for five days. The patient has a history of cirrhosis due to hepatitis C and received a living-donor renal transplant in 2010 as well as a liver transplant. The patient also has neuropathy, thought due to type II diabetes, and hypertension. Physical exam revealed weakness and sensory loss with decreased reflexes and stool incontinence localizing to L4-5, S1, S2, concerning for cauda equina syndrome. MR imaging showed degenerative changes, but no nerve root impingement. EMG-NCS showed mononeuritis multiplex. Serum testing showed free light chain elevations, with an elevated kappa:lambda ratio of 1.22, as well as elevated ESR and CRP; however, cryoglobulins, ANA, ENA, ANCA, and RPR were all negative. Operative procedure: Left sural nerve and left gastrocnemius muscle biopsies.
