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Microscopic polyangiitis complicated by oculomotor nerve palsy
Yuri Hiramatsu1, Takuya Kotani, Tohru Takeuchi
1Department of Internal Medicine (I), Osaka Medical College, Daigaku-Machi 2-7, Takatsuki, Osaka, Japan.
Background:
Microscopic polyangiitis (MPA) is a necrotizing vasculitis of the small vessels. Among the nerve lesions of MPA, the incidence of multiple mononeuritis is high, but cranial nerve palsy is rarely reported.
Case:
A female patient with oculomotor nerve palsy associated with MPA.
Observations:
The 68-year-old patient was admitted to our hospital with a high fever, numbness and weakness of the extremities, and muscle weakness. Multiple mononeuritis and purpura were observed. The urine was positive for occult blood and protein and the creatinine level was 1.2 mg/dL, indicating renal impairment. The levels of C-reactive protein (15.5 mg/dL) and myeloperoxidase-antineutrophil cytoplasmic antibody titers (600 ELISA units) were elevated. MPA was diagnosed, and 45 mg/day prednisolone was initiated. On the fifth day after the initiation of treatment, the patient suddenly developed diplopia and blepharoptosis of the left eye. Anisocoria and decreased light reflex as well as limited supraduction, infraduction, and adduction were also observed in the eye. Left oculomotor nerve palsy was diagnosed. The palsy gradually improved with continued prednisolone treatment.
Conclusions:
We encountered a rare case of MPA complicated by oculomotor nerve palsy.
Insights
Microscopic polyangiitis (MPA), a small vessel vasculitis, rarely causes cranial nerve palsy. This case highlights oculomotor nerve palsy as a rare complication of MPA, which improved with steroid treatment.
Area of Science:
- Neurology
- Rheumatology
- Internal Medicine
Background:
- Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis affecting small blood vessels.
- While multiple mononeuritis is a common neurological complication, cranial nerve palsies are infrequently reported in MPA patients.
Observation:
- A 68-year-old female presented with fever, limb weakness, purpura, and renal impairment, consistent with MPA.
- Following initiation of prednisolone treatment for MPA, the patient acutely developed left oculomotor nerve palsy, characterized by diplopia, ptosis, and limited eye movements.
Findings:
- The case details a rare instance of oculomotor nerve palsy occurring in the context of microscopic polyangiitis.
- Neurological symptoms, specifically cranial nerve involvement, can be an atypical manifestation of MPA.
Implications:
- This case underscores the importance of considering cranial nerve palsies in the differential diagnosis of MPA complications.
- Early recognition and management of MPA-associated neurological deficits, including oculomotor nerve palsy, are crucial for patient outcomes.
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