Department of Internal Medicine (I), Osaka Medical College, Daigaku-Machi 2-7, Takatsuki, Osaka, Japan.
Jpn J Ophthalmol. 2013 Mar;57(2):221-4. doi: 10.1007/s10384-012-0221-9. Epub 2012 Dec 11.
Microscopic polyangiitis (MPA) is a necrotizing vasculitis of the small vessels. Among the nerve lesions of MPA, the incidence of multiple mononeuritis is high, but cranial nerve palsy is rarely reported.
A female patient with oculomotor nerve palsy associated with MPA.
The 68-year-old patient was admitted to our hospital with a high fever, numbness and weakness of the extremities, and muscle weakness. Multiple mononeuritis and purpura were observed. The urine was positive for occult blood and protein and the creatinine level was 1.2 mg/dL, indicating renal impairment. The levels of C-reactive protein (15.5 mg/dL) and myeloperoxidase-antineutrophil cytoplasmic antibody titers (600 ELISA units) were elevated. MPA was diagnosed, and 45 mg/day prednisolone was initiated. On the fifth day after the initiation of treatment, the patient suddenly developed diplopia and blepharoptosis of the left eye. Anisocoria and decreased light reflex as well as limited supraduction, infraduction, and adduction were also observed in the eye. Left oculomotor nerve palsy was diagnosed. The palsy gradually improved with continued prednisolone treatment.
We encountered a rare case of MPA complicated by oculomotor nerve palsy.
显微镜下多血管炎（MPA）是一种小血管的坏死性血管炎。在 MPA 的神经病变中，多发性单神经炎的发病率较高，但很少有报告颅神经麻痹。
一位伴有 MPA 的动眼神经麻痹的女性患者。
这位 68 岁的患者因高热、四肢麻木无力和肌肉无力而入院。观察到多发性单神经炎和紫癜。尿潜血和蛋白阳性，肌酐水平为 1.2mg/dL，表明肾功能受损。C 反应蛋白（15.5mg/dL）和髓过氧化物酶-抗中性粒细胞胞质抗体滴度（600ELISA 单位）升高。诊断为 MPA，并开始每天服用 45mg 泼尼松龙。在开始治疗的第五天，患者突然出现左眼复视和上睑下垂。还观察到瞳孔不等大，左眼光反射减弱以及上转、下转和内收受限。诊断为左侧动眼神经麻痹。随着继续使用泼尼松龙治疗，麻痹逐渐改善。
我们遇到了一例罕见的 MPA 合并动眼神经麻痹的病例。
