Mononeuritis multiplex as an initial manifestation in small-vessel vasculitis: a case report in Mexico

Authors

  • Patricia Selene Contreras-Tovar Residente de Medicina Interna. Hospital General Regional de Orizaba No. 1 del IMSS. Veracruz, México.
  • Elizabeth Alvarado-Campos Departamento de Medicina Interna. Hospital General Regional de Orizaba No. 1 del IMSS. Veracruz, México.
  • Luis Fernando Montes de Oca-Saucedo Departamento de Rehabilitación. Hospital General Regional de Orizaba No. 1 del IMSS. Veracruz, México.
  • Emma María Escudero-Tepale Departamento de Reumatología. Hospital General Regional de Orizaba No. 1 del IMSS. Veracruz, México.

DOI:

https://doi.org/10.35366/107510

Keywords:

mononeuritis multiplex, vasculitis, Churg-Strauss syndrome, peripheral neuropathy, eosinophilia

Abstract

The eosinophilic granulomatosis with polyangiitis (EGP), also called Churg-Strauss syndrome, is a
systemic disorder of unknown etiology. It is characterized by necrotizing vasculitis affecting smalland medium-sized vessels, with multiple systemic manifestations. Eosinophilic vasculitis can affect
numerous organs and systems, including the integumentary, nervous, pulmonary, cardiovascular,
gastrointestinal, and renal systems. EGP is a rare disease with an incidence ranging from 2.4 to
4 cases/million inhabitants/year in the general population. This article presents a clinical case of a
63-year-old man with EGP. Currently, there are very few reports of Mexican patients with this disease.
Notably, those reports have described that the initial presentation is usually in the respiratory tract,
whereas the damage to the peripheral nervous system is a sequela. To our knowledge, our patient
is the first case in Mexico presenting rapidly progressive peripheral neuropathy symptoms as the
initial manifestation. Moreover, the patient does not present asthma, which nearly all EGP patients exhibit. In this regard, it is imperative to highlight that, although peripheral neuropathy does not
usually affect the survival of patients, the damage is generally permanent and can cause physical
disability, significantly impairing their quality of life. Therefore, timely diagnosis and treatment are
essential

References

Grayson PC, Ponte C, Suppiah R, Robson JC,

Craven A, Judge A et al. 2022 American College of

Rheumatology/European Alliance of Associations for

Rheumatology Classification Criteria for Eosinophilic

Granulomatosis with Polyangiitis. Ann Rheum Dis.

; 81 (3): 309-314.

Nishi R, Koike H, Ohyama K, Fukami Y, Ikeda S,

Kawagashira Y et al. Differential clinicopathologic

features of EGPA-associated neuropathy with and

without ANCA. Neurology. 2020; 94 (16): e1726-e1737.

Wolf J, Schmitt V, Palm F, Grau AJ, Bergner R.

Peripheral neuropathy as initial manifestation of primary

systemic vasculitides. J Neurol. 2013; 260 (4): 1061-

Roh YH, Koh YD, Noh JH, Gong HS, Baek GH. Low

median nerve palsy as initial manifestation of ChurgStrauss syndrome. J Hand Surg Am. 2017; 42 (6): 478.

e1-478.e4.

Cho HJ, Yune S, Seok JM, Cho EB, Min JH, Seo YL

et al. Clinical characteristics and treatment response of

peripheral neuropathy in the presence of eosinophilic

granulomatosis with polyangiitis (Churg-Strauss

syndrome): experience at a single tertiary center. J Clin

Neurol. 2017; 13 (1): 77-83.

Zhang Z, Liu S, Guo L, Wang L, Wu Q, Zheng W et

al. Clinical characteristics of peripheral neuropathy

in eosinophilic granulomatosis with polyangiitis: a

retrospective single-center study in China. J Immunol

Res. 2020; 2020: 3530768.

Villa A. Peripheral neuropathy as initial manifestation of

Churg-Strauss syndrome. Int Arch Intern Med. 2019; 3

(2): 1-4.

Padoan R, Felicetti M, Marconato M, Cinetto F, Agostini

C, Punzi L et al. Peripheral neuropathy in eosinophilic

granulomatosis with polyangiitis (EGPA). Incat disability

score to evaluate damage and to predict long term

outcome in 50 patients. Ann Rheum Dis. 2016; 75 (Suppl

: 574-575.

Kai Y, Yoshikawa M, Matsuda M, Suzuki K, Ohara H,

Iguchi N et al. Improvement of peripheral neuropathy

in a patient with antineutrophil cytoplasmic antibodynegative eosinophilic granulomatosis with polyangiitis by

additional mepolizumab. Allergy Asthma Clin Immunol.

; 18 (1): 14.

Tlacuilo-Parra A, Soto-Ortíz JA, Guevara-Gutiérrez

E. Churg-Strauss syndrome manifested by urticarial

plaques. Int J Dermatol. 2003; 42 (5): 386-388.

Vallejo E, Mendoza-González C, Aranda A. ChurgStrauss syndrome and myocardial perfusion SPECT

imaging. J Nucl Cardiol. 2004; 11 (3): 358-360.

Hernández-Bautista VM, Espinosa-Padilla SE,

Yamazaki-Nakashimada MA, López-Lara D, GonzálezSerrano E, Staines-Boone T et al. Pediatric ChurgStrauss syndrome in Mexico. Pediatr Pulmonol. 2006;

(4): 379-382.

Flores-Franco RA, Castillo-Soltero J, Pacheco-Tena CF.

Diaphragmatic paralysis in eosinophilic granulomatosis

with polyangiitis. Rheumat Clin. 2017; 14: 61-62.

Cervera-Castillo H, Blanco-Favela F, Silva-López YF,

Paredez-Rivera GE, Torres-Caballero V. ANCA-associated

vasculitides at Mexico City’s metropolitan eastern area. Rev

Med Inst Mex Seguro Soc. 2017; 55 (4): 430-440.

Chanussot-Deprez C, Vega-Memije ME, Flores-Suárez

L, Ríos-Romero C, Cabiedes-Contreras J, Reyes E et

al. Etiology of cutaneous vasculitis: utility of a systemic

approach. Gac Med Mex. 2018; 154 (1): 62-67.

Published

2022-12-30

How to Cite

1.
Contreras-Tovar PS, Alvarado-Campos E, Montes de Oca-Saucedo LF, Escudero-Tepale EM. Mononeuritis multiplex as an initial manifestation in small-vessel vasculitis: a case report in Mexico. InDiscap [Internet]. 2022 Dec. 30 [cited 2024 Nov. 21];8(3):103-9. Available from: http://dsm.inr.gob.mx/indiscap/index.php/INDISCAP/article/view/95

Issue

Section

Case reports and case series

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