Clinical History:
The patient is a 47-year-old man who presents with lower extremity swelling and pain x 5 days.
Past medical history: chronic alcohol abuse recently discharged from rehab program returned to drinking, smoking, anxiety/depression, and hypertension; suspect polysubstance abuse (including possible cocaine).
Medications: IV methylprednisolone, IVIG without clinical improvement.
Physical exam:
- Motor: marked distal weakness,
- Reflexes: biceps 1+ bilaterally, otherwise silent;
- Sensory: vibration, pinprick and light touch absent in stocking/glove distribution.
EMG/NCS suspicious for mononeuritis multiplex.
Lab results: CK 11956, ESR 70, ANCA negative, MPO negative, PR3 negative.
What is the underlying process based on the reference images below?
Answer:
Vasculitis
The second image shows eosinophilic fibrinoid necrosis (arrow) which is the diagnostic pathological finding of vasculitis.
Additionally, there is full thickness inflammation of the vessel wall and destruction of normal vascular wall structures.
Reference(s) / Additional Reading:
- Chkheidze R, Pytel, P. JNEN. 2020;79(4):355–364.
- Collins MP, Hadden RD. Nat Rev Neurol. 2017;13(5):302-316.
- Collins MP, Kissel JT, et al. J Peripher Nerv Syst. 2010;15(3):176-84.
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