A Case of Tuberculosis-related Leukocytoclastic Vasculitis Presenting With Peripheral Neuropathy

Abstract

Tuberculous granulomatous vasculitis is commonly associated with meningitis and retinitis. We describe a 39-year-old male, with a history of pulmonary tuberculosis (TB) who presented with progressive weakness, pain, tingling and numbness in the bilateral lower extremities. Significant atrophy and weakness of the lower extremities were evident along with absent reflexes. Nerve conduction studies and electromyography showed severe axonal polyneuropathy and denervation on the lower extremities. Nerve biopsy demonstrated small vessel leukocytoclastic vasculitis without any granuloma formation. Muscle biopsy was consistent with denervation and atrophy with target fiber changes. Tuberculosis-related vasculitis causing peripheral neuropathy is extremely rare and our case is unique in manifesting this presentation.

Leukocytoclastic‐vasculitic neuropathy

“…[4][5][6][7] Among these reports, Kanai et al 4 Our patient's skin/neurological findings, laboratory data, and response to the immune treatment were similar to these reports of LCV neuropathy. [4][5][6][7] There is a matter of debate as for discrepancy between clinical (sensory, quasi-symmetrical, globe, and stocking pattern; motor, right hand dominant) and nerve conduction study findings (multiple mononeuropathy). It is well described that neuropathy resulting from vasculitis presents with multiple mononeuropathy by nerve biopsy findings and nerve conduction study findings.…”

“…LCV is rarely accompanied by neurological complications, particularly neuropathy (LCV/EED neuropathy). [4][5][6][7] Here, we report such a rare case.…”

“…This is in contrast to medium‐sized or large arteries typically affected by polyarteritis nodosa. LCV is rarely accompanied by neurological complications, particularly neuropathy (LCV/EED neuropathy) . Here, we report such a rare case.…”

“…Leukocytoclastic vasculitis neuropathy has only rarely been reported . Among these reports, Kanai et al described a 55‐year‐old man with LCV neuropathy in association with Epstein‐Barr virus infection.…”

Bilateral Foot-Drop Secondary to Axonal Neuropathy in a Tuberculosis Patient With Co-Infection of COVID-19: A Case Report

“…Even though neurological manifestations of TB have been well documented throughout history in the form of central nervous system involvement such as tuberculous meningitis, tuberculomas and brain abscess, rare manifestations of TB that have been reported are peripheral nervous system involvement in the form of compression by vertebral collapse (Pott's disease) [14], and nerve compression by granulomatous tissue [15]. Still rarer forms include axonal sensorimotor polyneuropathy with only a handful of cases reported in literature attributing to variable mechanism: vasculitis, granulomas, and delayed hypersensitivity response [16][17][18]. Unfortunately, no such details could be isolated from this patient as a peripheral nerve biopsy was not done at the time due to COVID related concerns.…”