Scholarlink

Background <p>Mononeuritis multiplex is a recognized, though sometimes overlooked, clinical feature of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis. When renal or pulmonary involvement is initially mild, the condition may mimic common neurological disorders and diagnosis can be delayed.</p> Case presentation <p>A 51-year-old woman presented with a five-month history of progressive bilateral lower-limb pain and edema, followed by three weeks of rapidly progressive asymmetric weakness affecting all four limbs. Nerve conduction studies showed severe multifocal axonal neuropathy with marked side-to-side compound muscle action potential asymmetry, consistent with mononeuritis multiplex. Laboratory evaluation demonstrated anemia, hypoalbuminemia, proteinuria, microscopic hematuria, MPO-ANCA positivity, and a subsequent creatinine rise from 76 to 121 μmol/L, indicating early but clinically evident systemic involvement. Chest computed tomography showed right-sided nodular/parenchymal pulmonary lesions with bilateral chronic/interstitial changes. Treatment with glucocorticoid-based induction therapy together with a documented cyclophosphamide-containing discharge regimen was associated with marked early improvement in pain, strength, inflammatory markers, and renal indices.</p> Conclusions <p>Three red flags should prompt early ANCA testing in patients with rapidly progressive asymmetric axonal neuropathy: multifocal asymmetric axonal loss with relatively preserved conduction velocities on nerve conduction studies; early renal abnormalities such as hematuria, proteinuria, or rising creatinine; and concordant systemic findings including hypoalbuminemia, elevated inflammatory markers, or pulmonary imaging changes. Early recognition may allow treatment before axonal injury becomes irreversible.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Red flags in asymmetric axonal neuropathy revealing MPO-ANCA–associated microscopic polyangiitis: a case report

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年5月21日

查看全文
  • Yu Wang,
  • Na Liu,
  • Chunmei Yang,
  • Ju Zhu

摘要

Background

Mononeuritis multiplex is a recognized, though sometimes overlooked, clinical feature of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis. When renal or pulmonary involvement is initially mild, the condition may mimic common neurological disorders and diagnosis can be delayed.

Case presentation

A 51-year-old woman presented with a five-month history of progressive bilateral lower-limb pain and edema, followed by three weeks of rapidly progressive asymmetric weakness affecting all four limbs. Nerve conduction studies showed severe multifocal axonal neuropathy with marked side-to-side compound muscle action potential asymmetry, consistent with mononeuritis multiplex. Laboratory evaluation demonstrated anemia, hypoalbuminemia, proteinuria, microscopic hematuria, MPO-ANCA positivity, and a subsequent creatinine rise from 76 to 121 μmol/L, indicating early but clinically evident systemic involvement. Chest computed tomography showed right-sided nodular/parenchymal pulmonary lesions with bilateral chronic/interstitial changes. Treatment with glucocorticoid-based induction therapy together with a documented cyclophosphamide-containing discharge regimen was associated with marked early improvement in pain, strength, inflammatory markers, and renal indices.

Conclusions

Three red flags should prompt early ANCA testing in patients with rapidly progressive asymmetric axonal neuropathy: multifocal asymmetric axonal loss with relatively preserved conduction velocities on nerve conduction studies; early renal abnormalities such as hematuria, proteinuria, or rising creatinine; and concordant systemic findings including hypoalbuminemia, elevated inflammatory markers, or pulmonary imaging changes. Early recognition may allow treatment before axonal injury becomes irreversible.