Mononeuritis Multiplex Misdiagnosed as Multiple Lumbosacral Radiculopathies

Abstract

혈관염신경병증(Vascultic neuropathy)은 말초신경의 신경 외막 혈관(epineural artery)인 신경혈관의 염증반응으로 인해 혈전이 생성되어 허혈성 손상이 초래되어 발생하는 질환이다 [1]. 말초신경계 침범은 전신성 혈관염(Systemic vasculitis) 환 자에서 흔하며 약 30%까지 나타난다[2]. 이러한 혈관염신경병 증은 때때로 전신성 혈관염에서 첫 번째 증상으로 나타날 수 있 다[3]. We report a case involving a 71-year-old female patient with rheumatoid arthritis who presented with severe back pain, symmetrical distal lower limb pain and sensory abnormalities in her distal lower limbs for 2 months. Electrodiagnosis was performed and then diagnosed as multiple lumbosacral radiculopathies and peripheral polyneuropathy. After about 2 weeks, motor weakness and sensory loss in the lower extremities worsened. Mononeuritis multiplex was diagnosed on a follow up electrodiagnosis. Thereafter, the patient was transferred to rheumatology department for treatment. Steroid pulse therapy was attempted, however, due to complication after the first session, the treatment was not completed. After 10 months, there has been no change in the patient symptoms of distal limb weakness and sensory loss. This is a case of mononeuritis multiplex that was misdiagnosed multiple lumbosacral radiculopathies in a patient with rheumatoid arthritis.