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Skin denervation in vasculitic neuropathy.
Arch Neurol. 2005 Oct; 62(10):1570-3.AN

Abstract

BACKGROUND

Skin denervation in vasculitic neuropathy has rarely been documented despite frequent manifestations of small-fiber neuropathy including reduced sensitivity and neuropathic pain. Recently, skin biopsy has been established as a new approach to diagnose small-fiber sensory neuropathy.

OBJECTIVES

To investigate the pathologic features of cutaneous nerves and to evaluate inflammatory vasculopathy in the skin of patients with vasculitis.

DESIGN

Case series.

SETTING

National Taiwan University Hospital, Taipei. Patients Six patients with vasculitic neuropathy.

INTERVENTIONS

Patients had 3-mm punch biopsy specimens taken from the distal part of the leg (without active vasculitic lesions) and a sural nerve biopsy specimen was taken in addition to detailed neurologic examinations, laboratory investigations, and nerve conduction studies.

MAIN OUTCOME MEASURES

Results of nerve conduction studies, epidermal nerve fiber density studies, and immunohistochemistry.

RESULTS

All 6 patients had combined large- and small-nerve-fiber involvement on the neurologic examinations. Nerve conduction studies showed a pattern of axonal neuropathy or mononeuropathy multiplex. Epidermal nerve fiber densities were significantly reduced in the skin of all patients, consistent with concomitant small-fiber neuropathies. Perivascular infiltration by T cells and macrophages was demonstrated by immunohistochemistry. All patients experienced neurologic improvement in muscle strength and alleviation of sensory symptoms after immunotherapy with corticosteroids, plasma exchange, or cyclophosphamide.

CONCLUSIONS

Small-diameter sensory nerves are affected in vasculitis in addition to the well-known effect of vasculitis on large-diameter nerves. Significant inflammatory vasculopathy is present in the skin despite the absence of clinically active vasculitic lesions.

Authors+Show Affiliations

Department of Neurology, Pathology, and Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16216940

Citation

Lee, Jing-Er, et al. "Skin Denervation in Vasculitic Neuropathy." Archives of Neurology, vol. 62, no. 10, 2005, pp. 1570-3.
Lee JE, Shun CT, Hsieh SC, et al. Skin denervation in vasculitic neuropathy. Arch Neurol. 2005;62(10):1570-3.
Lee, J. E., Shun, C. T., Hsieh, S. C., & Hsieh, S. T. (2005). Skin denervation in vasculitic neuropathy. Archives of Neurology, 62(10), 1570-3.
Lee JE, et al. Skin Denervation in Vasculitic Neuropathy. Arch Neurol. 2005;62(10):1570-3. PubMed PMID: 16216940.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Skin denervation in vasculitic neuropathy. AU - Lee,Jing-Er, AU - Shun,Chia-Tung, AU - Hsieh,Song-Chou, AU - Hsieh,Sung-Tsang, PY - 2005/10/12/pubmed PY - 2005/11/16/medline PY - 2005/10/12/entrez SP - 1570 EP - 3 JF - Archives of neurology JO - Arch Neurol VL - 62 IS - 10 N2 - BACKGROUND: Skin denervation in vasculitic neuropathy has rarely been documented despite frequent manifestations of small-fiber neuropathy including reduced sensitivity and neuropathic pain. Recently, skin biopsy has been established as a new approach to diagnose small-fiber sensory neuropathy. OBJECTIVES: To investigate the pathologic features of cutaneous nerves and to evaluate inflammatory vasculopathy in the skin of patients with vasculitis. DESIGN: Case series. SETTING: National Taiwan University Hospital, Taipei. Patients Six patients with vasculitic neuropathy. INTERVENTIONS: Patients had 3-mm punch biopsy specimens taken from the distal part of the leg (without active vasculitic lesions) and a sural nerve biopsy specimen was taken in addition to detailed neurologic examinations, laboratory investigations, and nerve conduction studies. MAIN OUTCOME MEASURES: Results of nerve conduction studies, epidermal nerve fiber density studies, and immunohistochemistry. RESULTS: All 6 patients had combined large- and small-nerve-fiber involvement on the neurologic examinations. Nerve conduction studies showed a pattern of axonal neuropathy or mononeuropathy multiplex. Epidermal nerve fiber densities were significantly reduced in the skin of all patients, consistent with concomitant small-fiber neuropathies. Perivascular infiltration by T cells and macrophages was demonstrated by immunohistochemistry. All patients experienced neurologic improvement in muscle strength and alleviation of sensory symptoms after immunotherapy with corticosteroids, plasma exchange, or cyclophosphamide. CONCLUSIONS: Small-diameter sensory nerves are affected in vasculitis in addition to the well-known effect of vasculitis on large-diameter nerves. Significant inflammatory vasculopathy is present in the skin despite the absence of clinically active vasculitic lesions. SN - 0003-9942 UR - https://www.unboundmedicine.com/medline/citation/16216940/Skin_denervation_in_vasculitic_neuropathy_ L2 - https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/archneur.62.10.1570 DB - PRIME DP - Unbound Medicine ER -