Vasculitis & Neuropathy

A Vasculitis dx now rides on neurology tests.  I'm not deteriorating as quickly or as severely as I "should", SOME of my docs feel.  This started 18 months ago.

Biopsies done, of skin/nasal polyp.  Results inconclusive; either on Pred or treated already.  Skin has been determined "perivascular organizing LCV w/Lymphocyte infultrates & some Eosinophilia". Polyp showed "vague granulomatous vasculitis" - 2nd opinion = chronic inflammation.  Other diagnostic symptoms include asthma (atopic now more sensitive), parasinus abnorm (CT scan), and per. neuropathy.  MANY other CSS supporting symptoms.  ALL Bloods good, but, CRP either above norm or hovers.   Absolute EOS has been above-norm once, not % though.   Cornell Neurologist consult result - "Mononeuritis Multiplex".  NCS/EMG set for 10/17.

So,

- Can people with vasculitis have neuropathy on *some* level every day, but more significantly during a certain time period?  My periods of sig involvement occur about every 4-6 weeks.  Rhuem says that vasc neuro does not do this - it is likely compression(?)  I am a SAHM; moderately active, not overweight, don't overdo exercise or weight-lifting.  I don't buy compression in 4 limbs, even though severity varies greatly.  I don't sit, stand, or do repetitions for lengthly periods.  

- Can neuropathy be "immature" enough so that it will not produce a good reading?

- Are there ANY other diseases that can cause vasculitis-like symptoms with peripheral neuro - but in more of a flare; take long to develop - and be elusive with blood work?  I'm not diabetic, potass and electro levels good.

My meds do not have neuropathy as side effects either.

Thanks!  Pam.

[Kevin Pho, MD]

There can be some variation in the neurological manifestations of vasculitis.  Nerve compression typically does not affect all the limbs - I agree that points to a more systemic cause.  

That being said, I agree with the neurology workup to exclude any other exclusive process going on.  The NCS/EMG would be the most important test to exclude peripheral neuropathy.  

Every test will have a possibility of missing a finding - there is no test that is 100% sensitive.  Thus, it is always possible that the tests may miss a neurological finding.  

I am not aware of a specific rheumatologic disease can can present with such widespread neurologic symptoms.

These questions can be discussed with your personal physicians.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com