Re: Escalating Burning Sensory PN

Posted By CCF Neuro MD MJD on January 19, 1999 at 16:25:27:

In Reply to: Escalating Burning Sensory PN posted by Barry on January 16, 1999 at 14:43:10:






Dear CCF,
I have been diagnosed with Sensory PN following the use of a Fluroquinolone.
My question is this.  It is noted in the insert that
1. That physicians use Medrol to counteract an adverse and or allergic reaction.
2. But, it also states that the use of steriods can predispose someone
to Tendon Rupture/Tendonitis.
If that's the case, what role could Medrol play in escalating Sensory PN?
or escalating nerve damage/inflammation.  It seems in many cases people with Burning Sensations after Fluroquinolones are given Medrol to counteract the reaction and their conditions escalate to more acute burning!
3.I don't know what the clinical picture is for Steroid Myopathy but I didn't think it was Sensory PN?  Could you elaborate? I am trying to determine if the antibiotic alone did this or the combination of both!
4. Could you explain what the term Arthralagia Means?  I not only have the burning but it feels like my skin is stretched and there is alot of stiffness/joint pain.
5. Can a Paresthesia Cause acute burning pain that does not go away for
months? are Paresthesias associated with acute pain?
Thank you so much for having this forum and educating all of us!



  _____
Well, let me answer some of your latter questions first as they are definitions
Arthralgia is simply a technical term for Joint pain.
Paresthesias is an abnormal sensation seen in neurologic disorder - although annoying, it's not so much pain as a pins/needles sensation.  
Regarding the neuropathy - I realise that isolated reports have been popping up (especially on this forum) about a toxic neuropathy from fluoroquinolones, but I don't believe this is an established cause of neuropathy. Plus medication neuropathies are quite uncommon and difficult to establish cause and effect. So the first thing I would makes sure is that all the treatable/common causes of neuropathy have been evaluated for - diabetes, thyroid disease, paraproteinemic neuropathy (with an SPEP and immunofixation), inflammatory (with ESR / ANA).  Sometimes a spinal tap and nerve biosy is necessary to fully evaluate neuropathies.  Many times a cause can not be established.  As for the use of steroids, they should not cause or worsen neuropathies and are often used as treatment for inflammatory neuropathies.  Steroid myopathy should not be confused with sensory polyneuropathy - it generally occurs with prolonged steroid use (but can vary) and causes proximal muscular weakness and not numbness.  An EMG can help distinguish difficult cases.