Brachial Neuritis With Phrenic Nerve Involvement in a Patient With a Possible Connective Tissue Disease

Abstract

Background. Brachial neuritis (BN) is a rare inflammatory condition of peripheral nerves, usually involving the cervicobrachial plexus. These patients present with sudden onset of shoulder and arm pain that evolves into muscle weakness and atrophy.. Case Report. A 33-year-old woman presented with a 1-month history of diffuse pain in her thorax. She had no trauma or inciting incident prior to the onset of this pain and was initially treated for muscle spasms. The patient was seen in the emergency room multiple times and was treated with several courses of antibiotics for pneumonia on the basis of clinical symptoms and abnormal x-rays. The pleuritic chest pain persisted for at least 4 months, and the patient was eventually admitted for worsening pain and dyspnea. On physical examination, crackles were heard at both lung bases, and chest inspection revealed increased expansion in the upper thorax but poor expansion of the lower thorax and mild paradoxical respiration. “Sniff” test revealed no motion of the left hemidiaphragm and reduced motion on the right hemidiaphragm. Her computed tomography scan revealed bilateral atelectasis, more severe at the left base. She reported no symptoms involving her joints or skin or abdomen. Her presentation and clinical course are best explained by BN with a bilateral diaphragmatic weakness. However, she had a positive ANA, RF, anti-RNP antibody, and anti SS-A. Conclusion. Patients with BN can present with diffuse thoracic pain, pleuritic chest pain, and diaphragmatic weakness. Our patient may represent a case of connective tissue disease presenting with brachial plexus neuritis.

Autoamputation and Polyneuropathy in Mixed Connective Tissue Disorder: A Case Report

“…Other than dermatological findings, another purpose of this case report was to enlighten the neurological findings associated with mixed connective tissue disorder. Previously, conditions like trigeminal neuralgia, bilateral optic neuropathy, and transverse myelopathy have been seen in concordance with mixed connective tissue disease [ 5 - 6 ]. Another case of subacute progressive encephalopathy was described in mixed connective tissue disease secondary to vasculitis of central nervous system [ 7 ].…”