title: Non-Systemic Vasculitic Neuropathy: An Enigmatic Clinical Entity.
abstract: BACKGROUND
  Non-systemic vasculitic peripheral neuropathy is a rare condition characterized by necrotizing inflammation resulting in luminal narrowing of the vasa nervorum, leading to ischemic injury to peripheral nerves. Here, we present the case of 63-year-old woman with subacute onset of severe hyperesthesia of the lower extremities accompanied by foot drop.
  
  
  METHODS
  A 63-year-old woman with prolonged history of uncontrolled diabetes mellitus presented with subacute onset of severe bilateral lower extremity hyperesthesia and motor weakness along with left-sided foot drop. She had multiple emergency room visits with no relief of her symptoms. High doses of analgesics were insufficient to control pain. Laboratory tests were positive only for high erythrocyte sedimentation rate and C-reactive protein. A skin biopsy obtained 5 cm above the left lateral malleolus revealed medium-sized dermal vasculitis with dense mononuclear infiltrate. Electromyography showed peripheral neuropathy. A nerve biopsy was needed to reveal the exact diagnosis.
  
  
  CONCLUSIONS
  Diagnosis of non-systemic vasculitic peripheral neuropathy can be delayed or missed in patients with uncontrolled diabetes mellitus, leading to significant morbidity. Elevated markers of inflammation in the absence of a possible explanation should prompt the clinician to perform a nerve biopsy; however, it is an invasive procedure and is associated with complications of post-neuropathic pain and delayed wound healing. Magnetic resonance angiography of the lower limbs, if combined with skin biopsy, can save the patient from undergoing nerve biopsy.
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.
authors.forename: Sandeep Singh
authors.initials: SS
authors.lastname: Lubana
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Singh
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Sanelli-Russo
authors.affiliation: Department of Rheumatology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.
authors.forename: Adriana
authors.initials: A
authors.lastname: Abrudescu
mesh_terms: D000792:Angiography; D001706:Biopsy; D004576:Electromyography; D005260:Female; D005267:Femoral Nerve / Q000473:pathology*; D020428:Femoral Neuropathy / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D014650:Vasa Nervorum / Q000473:pathology*; D014657:Vasculitis / Q000150:complications / Q000175:diagnosis*