Disclosures: Christopher J. Bill, MD: Nothing to disclose

Case Description: Patient initially presented with abdominal pain, lower extremity paresthesias and multiple falls. Her lower extremity paresthesias had been worsening over the previous 2 months in all four extremities. She reported involvement of bilateral hands and bilateral lower extremities from her knees downwards. EMG demonstrated a sensory motor demyelinating and axonal polyneuropathy with denervation in distal greater than proximal distribution. Magnetic resonance imaging of the lumbar spine was unremarkable. Serologic testing demonstrated low thiamine, positive antinuclear antibody, double-stranded deoxyribonucleic acid and serum cryoglobulin. Corticosteroids and thiamine were administered. Patient was discharged to home however was non-adherent to medications, follow-up appointments and re-presented. On repeat admission asialo ganglioside-monosialic acid antibody and both Sjogren’s A and B antibodies were noted to be positive. Rheumatology was consulted. Left sural nerve biopsy was performed with axonopathic features, no myopathic or vasculitic features were identified.

Setting: Tertiary Care Hospital

Patient: 62-year-old African American female with a pertinent past medical history including alcohol abuse and untreated hepatitis C

Assessment/Results: Patient underwent inpatient rehabilitation, thiamine supplementation and corticosteroids. She was discharged to home, but quickly re-presented with similar symptoms. Patient underwent 5-day course of intravenous immunoglobulin, and prednisone was resumed with mild improvement. Immunosuppressive therapy was not a treatment option at that time per rheumatology.

Discussion: On literature review, there are reports of peripheral neuropathies associated with mixed connective tissue disease. Often peripheral neuropathies are ascribed to a feature in the patient’s past medical history such as diabetes, alcohol abuse, hepatitis C or additional medical conditions. This case is of interest as despite multiple reasons for a peripheral neuropathy, the underlying cause had not been previously diagnosed.

Conclusion: Distal symmetric sensorimotor axonopathy can be seen with connective tissue disease and may be the first or only clinical sign. When presented with a peripheral neuropathy it is important to maintain a wide differential regarding potential causes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/sensorimotor-polyneuropathy-in-a-patient-with-previously-undiagnosed-mixed-connective-tissue-disease/