Table of Contents
Washington University Experience | PERIPHERAL NEUROPATHY | 11 VASCULITIS - VASCULOPATHY | 3 Vasculitis - NOS | 29A0 Case 29 History - Copy
Case 29 History ---- The patient is a 44-year-old man with a history of seizures, reported obsessive compulsive disorder (OCD), and depression, who presented to an outside institution (OSH) with bilateral lower extremity numbness and weakness that began suddenly on 01/30. Serum CK was 25267. MRI noted extensive paraspinal muscle edema, left worse than right. LP/CSF results were unremarkable. He was treated with IV fluid for rhabdomyolysis, doxycycline for possible infection, and morphine for pain. He was transferred to BJH on 02/03. Further work up showed serum CK 1517 (02/04) and 172 (02/14); ANA was initially positive but was consistently negative on repeat; ANCA/dsDNA/RF were negative; complement (C3/C4) was within normal limits; ESR 23; CRP 13; HIV/RPR/HBV/HCV negative; serum immunofixation, copper, zinc, B12 and MMA all within normal limits. CT of the chest, abdomen and pelvis showed no evidence of malignancy. EMG findings were concerning for lumbosacral radiculoplexus neuropathy versus mononeuritis multiplex, with overlying myopathic features. A vascular laboratory report described a left soleal acute deep venous thrombus. Skin biopsy, performed at the OSH and reviewed at Washington University in consultation, showed excoriation with dermal necrosis and vascular thrombosis. Operative procedure: Right gastrocnemius muscle biopsy and right sural nerve biopsy.
