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Título

MULTIPLE MONONEURITIS SECONDARY TO VASCULITIS AS A DIFFERENTIAL DIAGNOSIS OF THE GUILLAIN-BARRÉ SYNDROME

RESUMO

CASE PRESENTATION:A 46-year-old female patient with a history of burning pain and paresthesia on the left foot and progressing to the right foot. Subsequently, the worsening of sensory complaints, besides motor involvement, with ascending progression of symptoms and involvement of the upper limbs. In the physical exam, edema and ecchymosis on the lower limbs; hypoperfused podotactiles; predominantly distal flaccid tetraparesis, with an asymmetrical pattern; normoactive deep tendinopathic reflexes, except for abolished right Achilles; and apalesthesia on the right podotactiles, suggesting the hypothesis of Guillain-Barré Syndrome and was maid guided pulse therapy with immunoglobulin without clinical improvement. In the investigation, serologies were negative, laboratory evaluation of suspected vasculitis and connective tissue was reagent for rheumatoid factor, ANA, and lupus anticoagulant, polyclonal gammopathy detected by serum protein electrophoresis. CSF did not present alterations. Electroneuromyography disclosed severe asymmetrical sensory-motor axonal neuropathy and signs of denervation. Lumbar spine magnetic resonance didn’t present alterations. Diagnosis of multiple mononeuritis secondary to systemic vasculitis was suspected, and pulse therapy with methylprednisolone was initiated, with an improvement of peripheral nervous symptoms. The patient evolved during hospitalization with cardiac and central nervous system involvement, and died due to the severity of the disease. DISCUSSION: The mononeuritis multiplex clinical presentation is linked to progressive motor and sensory deficits through the distribution of specific peripheral nerves, with irregular and asymmetrical characteristics. Ordinarily, it’s caused by vasculitis, due to an inflammatory process that results in multifocal ischemia or peripheral nerve infarction. It presents a predilection for the extremities of lower limbs and has acute and subacute rhythms. The acute mononeuritis multiplex being similar to the Guillain-Barré Syndrome. The early diagnosis and proper treatment can prevent comorbidities and reduce mortality, namely to reduce the damage and consequently improve the quality of life. FINAL CONSIDARATIONS: Guillain-Barré has a clinical presentation similar to acute-onset multiple mononeuritis. Thus, it is important to evaluate the differential diagnoses of the cases with acute evolution which can have high mortality if there is delay in diagnosis and treatment.