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[Subacute necrotizing lymphadenitis associated with mononeuritis multiplex. A case report].

Y Tsuboi¹, I Hayashi, T Hori

¹Department of Internal Medicine and Health Care, School of Medicine, Fukuoka University.

Rinsho Shinkeigaku = Clinical Neurology

|July 7, 1999

Summary

Subacute necrotizing lymphadenitis, typically benign, can cause severe neurological issues like mononeuritis multiplex. This case highlights vasculitis and nerve damage, responding to corticosteroid treatment.

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Area of Science:

Neurology
Immunology
Pathology

Background:

Subacute necrotizing lymphadenitis (SNLA) is generally considered a benign condition.
Reported neurological complications of SNLA are rare, including aseptic meningitis and cerebellar ataxia.
Mononeuritis multiplex, a severe neurological complication, has not been previously associated with SNLA.

Observation:

A 20-year-old male presented with cervical lymphadenopathy, progressing to hand and lower extremity weakness.
Neurological examination revealed ulnar and peroneal nerve palsies, confirmed as severe axonopathy by nerve conduction studies.
Testicular necrosis with vasculitis was observed, alongside axonal degeneration and arterial wall thickening in sural nerve biopsy.

Findings:

The patient experienced mononeuritis multiplex, characterized by nerve palsies and axonal degeneration.

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Vasculitis affecting small arteries was identified in both the sural nerve and testis.

Corticosteroid therapy proved effective in managing the patient's symptoms.

Implications:

This case expands the known spectrum of neurological complications associated with subacute necrotizing lymphadenitis.
The findings suggest a potential host immune response to an initial viral infection may trigger both SNLA and vasculitic neuropathy.
Further research is warranted to elucidate the pathogenesis of SNLA-associated vasculitis and neurological sequelae.