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Updated: Jan 10, 2026

Nerve Ultrasound Protocol to Detect Dysimmune Neuropathies
Published on: October 7, 2021
Severe lupus vasculitic neuropathy
Apoorva Anil Kumar1, Victor Jia Wei Zhang2, Carine J Moezinia2
1National Hospital for Neurology and Neurosurgery, London, UK apoorvaanil.kumar@nhs.net.
Severe axonal sensorimotor neuropathy can be an early sign of neurological lupus. Prompt diagnosis and treatment with immunosuppression, like cyclophosphamide and prednisolone, led to significant improvement in a patient with multisystem lupus vasculitis.
Area of Science:
- Neurology
- Rheumatology
- Immunology
Background:
- Peripheral neuropathy is an under-recognized presenting manifestation of neurological lupus.
- Systemic lupus erythematosus (SLE) can affect the nervous system, leading to diverse neurological complications.
- Vasculitic processes are a key consideration in patients with rapidly progressive neuropathy and systemic symptoms.
Purpose of the Study:
- To highlight the diagnostic challenges in a case of severe axonal sensorimotor neuropathy secondary to lupus vasculitis.
- To discuss the interpretation of autoantibody serology following intravenous immunoglobulin (IVIG) treatment.
- To emphasize the importance of recognizing peripheral neuropathy as a potential initial presentation of neurological lupus.
Main Methods:
- Case report of a 31-year-old woman with generalized pain and weakness.
- Diagnostic workup including autoantibody testing (lupus and antiphospholipid antibodies).
- Treatment initiated with cyclophosphamide and prednisolone for severe multisystem lupus vasculitis.
Main Results:
- The patient presented with rapidly progressive axonal sensorimotor neuropathy, preceded by transient joint symptoms, rash, and hair loss.
- Blood tests revealed strongly positive lupus and antiphospholipid antibody titres post-IVIG treatment.
- Treatment with cyclophosphamide and prednisolone resulted in notable clinical improvement.
Conclusions:
- Peripheral neuropathy can be a critical early indicator of neurological lupus.
- Careful interpretation of serological results is necessary, especially after treatments like IVIG.
- Multisystem lupus vasculitis requires timely immunosuppressive therapy for effective management and improved patient outcomes.
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