A diagnostic dilemma: a case report

Abstract

BackgroundA seventy nine year old lady presented with acute bilateral foot drop and paraesthesia of her lower limbs as a presenting feature of Wegener's Granulomatosis (WG).Case presentationThere was no evidence of pulmonary involvement and her renal function was normal. WG can masquerade as very diverse pathology. It is recognised that neuropathy can occur early and often in the absence of more classical pulmonary and renal findings, often resulting in a delay in diagnosis.ConclusionAnti-neutrophil cytoplasmic antibody (ANCA) testing was particularly useful in this case permitting early diagnosis.

Granulomatosis with polyangitis with mononeuritis multiplex-immunosuppressives playing a double-edged sword

“…Rarely neurological manifestations may be the initial presentation. [ 7 ] Peripheral neuropathy in the form of mononeuritis multiplex is the commonest neurological manifestation. [ 8 ] Demonstration of necrotizing vasculitis and granuloma on biopsy is confirmatory for diagnosis of GPA, but a high index of clinical suspicion combined with a positive C-ANCA in high titer by the ELISA method is also sufficient for the diagnosis of GPA in the absence of biopsy.…”