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BMJ Case Reports 2010; doi:10.1136/bcr.11.2009.2423
  • Unusual presentation of more common disease/injury

An unusual case of relapsing remitting mononeuritis multiplex

  1. Michael Johnson3
  1. 1Queen Elizabeth Hospital, Neurology, Queen Elizabeth Medical Centre, Edgebaston, Birmingham, B15 2TH, UK
  2. 2The National Hospital for Neurology and Neurosurgery, Neurology, Queen Square, London, WC1N 3BG, UK
  3. 3Leeds General Infirmary, Neurology, Great George Street, Leeds, LS1 3EX, UK
  1. Correspondence to Penelope Eames, pjveames{at}gmail.com
  • Published 19 May 2010

Summary

A 50-year-old man with a past history of autoimmune disease presented with posterior uveitis followed by relapsing remitting mononeuritis multiplex and hypersensitivity to pain despite continuation of high doses of steroids and the introduction of other immunosuppressive agents. Extensive initial investigations, including high resolution chest CT, were negative apart from a raised serum angiotensin-converting enzyme (ACE). The patient was initially thought to have sarcoidosis and treated with high dose prednisolone, but developed a series of cranial nerve palsies on treatment, some of which improved without any change in treatment. Vasculitis was suspected and steroid sparing agents introduced. Ten months after the first visual symptoms, constitutional symptoms became a feature of the illness and new cranial nerve palsy developed quite suddenly after a pulse of steroid, prompting further review. Non-Hodgkin’s lymphoma was finally diagnosed following vitrectomy.

Footnotes

  • Competing interests: None.

  • Patient consent: Patient/guardian consent was obtained for publication.

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