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Título

MULTIPLE MONONEURITIS SECONDARY TO RHEUMATOID VASCULITIS

RESUMO

CASE PRESENTATION: A 60-year-old male patient, diabetic, hypertensive and rheumatoid arthritis without treatment, started about 2 months ago with multiple cutaneous lesions on lower members without pruritic purpuric appearance with dissemination from upper limbs and face. Beside that, the patient presents pain and paresthesia on the plantar region. In the physical exam it was observed: ulnar deviation of the fingers on symmetrical hands with bone prominences on metacarpophalangeal joints. Neurological examination: oriented, tactile and painful hypoesthesia on the left lower limb, strength grade 2 on the left lower limb and grade 3 on the right lower limb and upper limbs with global hyporeflexia. The serologies for HIV, hepatitis B and C were negative with evidence of thrombocytosis, reactive rheumatoid factor (1280 UI), no-reactive FAN, decreased C4 dosage and normal C3 dosage. The electroneuromyography showed a peripheral sensory-motor involvement, of axonal nature, asymmetrical involvement, subacute, acute grade, compatible with multiple mononeuritis. A diagnosis of rheumatoid arthritis complicated with rheumatoid vasculitis was made. Pulse therapy was initiated with methylprednisolone for 5 days and associated with gabapentin for neuropathic pain treatment. Patient evolved with improvement of skin lesions, strength of the lower limbs, plantar and hands paresthesia after the pulse therapy. Opted for hospital discharge and maintenance treatment with rituximab. DISCUSSION: The rheumatoid arthritis is a chronic and systemic inflammatory disease progressive that involves joints, but also can show extra-articular manifestations, such as vasculitis. Rheumatoid vasculitis is a rare and serious complication that must have an early diagnosis, given the great interference in the evolution, treatment and prognosis of the base disease. The peripheral nervous system is affected in 50% of the cases. The worst prognosis of multiple mononeuritis occur with acute installation, axonal degeneration and presence of extensive and severe angiitis. FINAL CONSIDERATIOS:Rheumatoid vasculitis is a complication rare and severe of rheumatoid arthritis , that can be associated with others comorbidities, in especial the acute multiple mononeuritis that needs an aggressive early treatment for the reduction of the morbidity and mortality.

Palavras Chave

MULTIPLE MONONEURITIS; RHEUMATOID ARTHRITIS; VASCULITIS