Polyneuropathy as initial manifestation of necrotizing vasculitis and gangrene in systemic lupus erythematosus.

A patient with necrotizing vasculitis and systemic lupus erythematosus is reported. The vasculitis presented as a symmetrical sensorimotor axonal neuropathy and after three months it resulted in gangrene of a toe. Sural nerve conduction was abnormal and a biopsy of this nerve was diagnostic. Serum anti-endothelial cell antibodies were elevated during activity of the vasculitic process. Treatment with prednisone and cyclophosphamide induced a remission.