Isahaya Kenji, Shiraishi Makoto, Tanaka Keita, Sasaki Rie, Kawakami Tamio, Hasegawa Yasuhiro
Department of Neurology, St. Marianna University School of Medicine.
Department of Dermatology, St. Marianna University School of Medicine.
Rinsho Shinkeigaku. 2017 Jun 28;57(6):307-310. doi: 10.5692/clinicalneurol.cn-001013. Epub 2017 May 26.
A 55-year-old man was admitted with paralysis of the left lower leg. He had purpura in the left lower extremity for three years, left calf pain for two years, and dysesthesia in the left plantar region and first toe for one year. A physical examination revealed livedo reticularis on the left leg and mononeuritis multiplex was diagnosed in the bilateral tibial and left peroneal nerve area. Anti-neutrophil cytoplasmic antibody was negative. A nerve conduction study showed decreased amplitude of compound muscle-action potential in the bilateral tibial and the left peroneal nerve, sensory nerve action potential in the bilateral sural nerve. A skin biopsy revealed inflammatory cells on blood vessel walls and cutaneous arteritis was diagnosed. Cyclophosphamide pulse therapy with steroid and anti-coagulation improved the neurological symptoms. A skin biopsy should be considered when patients present with mononeuritis multiplex in the lower extremities and cutaneous findings such as livedo reticularis in the symptomatic area.
一名55岁男性因左小腿麻痹入院。他左下肢出现紫癜三年，左小腿疼痛两年，左足底区域和第一趾感觉异常一年。体格检查发现左腿有网状青斑，双侧胫神经和左侧腓总神经区域诊断为多发性单神经炎。抗中性粒细胞胞浆抗体为阴性。神经传导研究显示双侧胫神经和左侧腓总神经的复合肌肉动作电位幅度降低，双侧腓肠神经的感觉神经动作电位降低。皮肤活检显示血管壁有炎症细胞，诊断为皮肤动脉炎。环磷酰胺脉冲疗法联合类固醇和抗凝治疗改善了神经症状。当患者出现下肢多发性单神经炎并有症状区域的皮肤表现如网状青斑时，应考虑进行皮肤活检。
