Clinical History:
This 52-year-old patient presented with increased weakness and mildly painful paresthesias. Imaging showed hilar adenopathy and a rheumatology consult showed suspicion for sarcoidosis.
Question:
Sural nerve and vastus lateralis biopsies show evidence of:
A. Non-caseating granuloma
B. Vasculitis
C. Diabetic vasculopathy
D. Lyme Disease
Answer: B. Vasculitis <– correct answer
Vasculitis
Figure 1- Post vasculitic changes
A. Nerve- patchy/zonal loss of myelinated axons (red on Gomori trichrome)
B. Muscle- grouped atrophy; almost always acute+chronic neurogenic changes
C. Vessel- recanalization of injured vessel; multiple lumena
D. Vessel- Loss of >1/4 internal elastic lamina (red arrows); characteristic of prior vasculitis
Urgent diagnosis- untreated vasculitis may cause rapid and irreversible injury; always warrants call to referring physician.
Reference(s)/ Additional Reading:
Collins MP, Dyck PJB, Hadden RDM. Update on classification, epidemiology, clinical phenotype and imaging of the nonsystemic vasculitic neuropathies. Curr Opin Neurol. 2019 Oct;32(5):684-695.
Collins MP, Hadden RD. The nonsystemic vasculitic neuropathies. Nat Rev Neurol. 2017 Apr 27;13(5):302-316.
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