Severe guillain-barre-like peripheral neuropathy in a patient with systemic lupus erythematosus: recovery after two separate accidental burn injuries.
A 19-year-old woman with systemic lupus erythematosus (SLE) developed Guillain-Barre like ascending motor paralysis with sensory neuropathy and was subsequently documented to have "necrotizing vasculitis" by sural nerve biopsy. After 1 month of aggressive treatment with high-dose corticosteroids, plasmapheresis, i.v. gamma globulin and cyclophosphamide, there was limited improvement in her neurologic examination. The patient was discharged with bilateral foot-drop and complete sensory loss in the lower legs. There was no improvement in her neurologic status for several months until she had two separate accidental burn injuries, first in the right leg then in the left, after which the motor and sensory function in each leg began to rapidly recover. This case not only illustrates an unusual pattern of neuropathy in SLE but also allows us to postulate that thermal injury may effect the function of stunned nerves by impairing immune function.
Erkan
D
D
Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York; Division of Rheumatology, Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York.
Merrill
J T
JT