Vasculitic Peripheral Neuropathy, Differences Between Systemic and Non-Systemic Etiologies: A Case Series and Biopsy...

Area of Science:

• Neurology
• Immunology
• Pathology

Background:

• Vasculitic peripheral neuropathy (VPN) results from inflammation of blood vessels affecting peripheral nerves.
• VPN is categorized as Systemic Vasculitic Neuropathy (SVN) when associated with systemic disease, or Non-Systemic Vasculitic Neuropathy (NSVN) when isolated to nerves.

Purpose of the Study:

• To compare clinical features, biopsy findings, and outcomes in patients diagnosed with VPN.
• To identify distinguishing factors between SVN and NSVN.

Main Methods:

• Retrospective review of adult VPN patient records from June 2002 to June 2019.
• Analysis of demographic data, clinical symptoms, nerve conduction studies, nerve biopsies, treatments, and clinical evolution.
• Inclusion criteria required at least 6 months of follow-up.

Main Results:

• No significant demographic or clinical differences were observed between SVN (n=10) and NSVN (n=15) groups.
• NSVN patients had a longer median delay from symptom onset to nerve biopsy (10 vs. 5.5 months).
• Elevated erythrocyte sedimentation rate (ESR > 20 mm/h) was more frequent in SVN (100% vs. 60%).
• Treatment-naive patients showed higher rates of active nerve biopsy lesions (92% vs. 38%) and definite VPN diagnoses (92% vs. 46%) compared to those pre-treated with corticosteroids.

Conclusions:

• While clinical presentations are similar, ESR is a valuable marker for differentiating SVN and NSVN.
• Prompt nerve biopsy in untreated patients enhances diagnostic accuracy for VPN, preventing misdiagnosis.