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Washington University Experience | PERIPHERAL NEUROPATHY | 9B PERINEURITIS & PERINEURIAL PATHOLOGY | 1H8 Epineuritis & Perineuritis (Case 1) Immune checkpoint Plastic 40X
The scattered presence of lipid debris suggests active axonal degeneration; however, few thin for caliber myelinated axons are present in the background and regenerative clusters are rare. There are markedly diminished large myelinated axons but small myelinated axons are also lost in significant numbers. The results are a surprise since the NF immunostains appear to show better axonal preservation. A subset of endoneurial and perineurial blood vessels show thickening of their walls. (Plastic sections) ---- Not shown: NCAM studies in the Pestronk laboratory show a normal to slightly reduced number of non-myelinating Schwann cells among fascicles. ---- Denouement: One published investigation of a very similar patient treated with a combination of ipilimumab and nivolumab for metastatic melanoma and a review of the literature show an acute sensorimotor neuropathy with an axonal pattern and hyporeflexia. (PMID: 28765062)
