Ogawa Nobuhiro, Kawai Hiromichi, Yamakawa Isamu, Sanada Mitsuru, Sugimoto Toshiro, Maeda Kengo
Division of Neurology, Department of Internal Medicine, Shiga University of Medical Science.
Rinsho Shinkeigaku. 2010 May;50(5):301-5. doi: 10.5692/clinicalneurol.50.301.
A 70-year-old woman was admitted to our hospital because of fever, numbness in her extremities and right drop foot. Because her hip prosthesis had loosened as a result of infection, she had been taking 100 mg of minocycline orally for eight months. Three months before admission, she had had melena several times and body weight loss and pyrexia developed. A month before admission, asymmetrical paresthesia and numbness appeared in her extremities and finally right drop foot developed. Laboratory tests showed elevated C-reactive protein and positive anti-nuclear antibody. Abnormalities found in nerve conduction study were compatible with mononeuritis multiplex. Sural nerve biopsy revealed an occluded medium-size artery in the epineurium and axonal degeneration in the nerve fascicles, confirming the diagnosis of vasculitic neuropathy. These manifestations met the American Congress Rheumatology criteria for polyarteritis nodosa. However, her clinical conditions markedly improved after discontinuing minocycline and therefore she was diagnosed as having minocycline-induced vasculitic neuropathy. Although minocycline-induced vasculitis is a well known adverse effect of the drug, peripheral neuropathy with biopsy findings has rarely been reported. Drug induced-vasculitis is important as a differential diagnosis for mononeuritis multiplex because the symptoms can be improved by the discontinuation of an offending drug.
一名70岁女性因发热、四肢麻木和右足下垂入住我院。由于感染导致她的髋关节假体松动，她已经口服100毫克米诺环素八个月。入院前三个月，她多次出现黑便，并出现体重减轻和发热。入院前一个月，她的四肢出现不对称感觉异常和麻木，最终发展为右足下垂。实验室检查显示C反应蛋白升高，抗核抗体阳性。神经传导研究发现的异常与多发性单神经炎相符。腓肠神经活检显示神经外膜中动脉闭塞，神经束内轴索变性，确诊为血管炎性神经病变。这些表现符合美国风湿病学会结节性多动脉炎的标准。然而，停用米诺环素后她的临床状况明显改善，因此她被诊断为米诺环素诱导的血管炎性神经病变。虽然米诺环素诱导的血管炎是该药物众所周知的不良反应，但伴有活检结果的周围神经病变很少被报道。药物性血管炎作为多发性单神经炎的鉴别诊断很重要，因为停用致病药物后症状可改善。
