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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Autores principales:	Wasundara Wathurapatha, B. G. A. Rathnamali, Upul Dissanayake
Formato:	article
Lenguaje:	EN
Publicado:	Hindawi Limited 2021
Materias:	Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/6b412d3522854d0f8e18ddb795541777
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spelling	oai:doaj.org-article:6b412d3522854d0f8e18ddb7955417772021-11-08T02:36:44ZSensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with Polyangiitis2090-689710.1155/2021/5353575https://doaj.org/article/6b412d3522854d0f8e18ddb7955417772021-01-01T00:00:00Zhttp://dx.doi.org/10.1155/2021/5353575https://doaj.org/toc/2090-6897Granulomatosis 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.Wasundara WathurapathaB. G. A. RathnamaliUpul DissanayakeHindawi LimitedarticleDiseases of the musculoskeletal systemRC925-935ENCase Reports in Rheumatology, Vol 2021 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the musculoskeletal system RC925-935
spellingShingle	Diseases of the musculoskeletal system RC925-935 Wasundara Wathurapatha B. G. A. Rathnamali Upul Dissanayake Sensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with Polyangiitis
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
author	Wasundara Wathurapatha B. G. A. Rathnamali Upul Dissanayake
author_facet	Wasundara Wathurapatha B. G. A. Rathnamali Upul Dissanayake
author_sort	Wasundara Wathurapatha
title	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_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_sort	sensory-motor polyneuropathy and digital ischemia: a rare presentation of granulomatosis with polyangiitis
publisher	Hindawi Limited
publishDate	2021
url	https://doaj.org/article/6b412d3522854d0f8e18ddb795541777
work_keys_str_mv	AT wasundarawathurapatha sensorymotorpolyneuropathyanddigitalischemiaararepresentationofgranulomatosiswithpolyangiitis AT bgarathnamali sensorymotorpolyneuropathyanddigitalischemiaararepresentationofgranulomatosiswithpolyangiitis AT upuldissanayake sensorymotorpolyneuropathyanddigitalischemiaararepresentationofgranulomatosiswithpolyangiitis
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Sensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with Polyangiitis

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