Acute fulminant symmetrical vasculitic polyneuropathy: need for early biopsy

We report 2 patients with acute symmetrical axonal motor and sensory polyneuropathy associated with vasculitis. The clinical presentation in each case was not that of a mononeuritis multiplex. Serial electrophysiological studies in 1 of the patients documented the development of confluent axonal degeneration involving several motor and sensory territories over the same period of time. In both patients the diagnosis of necrotizing vasculitis was established by peripheral nerve biopsy and recovery followed treatment with prednisone and cyclophosphamide. Biopsy of an involved nerve should be routinely sought in unexplained acute axonal polyneuropathies.