Disclosures: Kathlin Ramsdell, MD: No financial relationships or conflicts of interest

Case Description: A 71-year-old man with a history of stroke with mild residual right-sided hemiparesis was admitted to the hospital for rapidly progressive bilateral lower extremity weakness. He had recently been evaluated by outpatient neurology for a two-month gradual decline in lower extremity strength requiring the use of a rolling walker. Electrodiagnosis (EDX) demonstrated multifocal axonal neuropathy and brain magnetic resonance imaging (MRI) revealed multiple infarcts of varying ages. A malignant workup was unremarkable. The patient received intravenous immunoglobulin with no improvement. Rheumatology was consulted for an elevated erythrocyte sedimentation rate and positive antinuclear antibodies. Further workup revealed elevated rheumatoid factor, positive hexagonal phase phospholipid and positive cardiolipin ant-immunoglobulin M antibodies. He was treated with intravenous steroids with significant improvement in his strength. Given these findings, along with an abnormal MRI and EDX, the patient met the criteria for vascular lupus. He was started on warfarin for antiphospholipid syndrome as well as plaquenil, aspirin and oral prednisone. He then completed a course of inpatient rehabilitation where he made significant functional gains.

Setting: Community campus, University hospital

Patient: 71-year-old male with progressive, bilateral, lower extremity weakness Assessment/

Results: After rehabilitation, he followed up with outpatient rheumatology where he was officially diagnosed with lupus and antiphospholipid syndrome. This presentation is unique as his symptoms began with peripheral nervous system pathology discovered with EDX. He was instructed to continue warfarin and plaquenil, to taper off prednisone, and to follow up with rheumatology.

Discussion: Peripheral neuropathy is a known but relatively uncommon manifestation of lupus, and when it does occur it is often years after the diagnosis. However, our case demonstrates that polyneuropathy can precede, and ultimately assist in determining, a diagnosis of lupus.

Conclusion: Axonal polyneuropathy with resultant lower extremity weakness is a possible initial manifestation of lupus vasculitis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/axonal-polyneuropathy-as-the-initial-manifestation-of-lupus-a-case-report/