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Multiple Mononeuropathy Associated with Livedoid Vasculopathy: A Case Report and Review

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초록

This report describes a rare case of livedoid vasculopathy (LV) with sensory and motor neurologic deficits. A 46-year-old woman who had been diagnosed with LV developed acute left-foot drop. An electrodiagnostic study showed multiple mononeuropathy involving both the common peroneal and sural nerves, primarily on the left side. Nerve biopsy findings showed intravascular thrombosis in the perineurium and extensive infarct of the peripheral nerve. The patient was prescribed continuous anticoagulants, which resulted in a good clinical outcome. LV associated with multiple mononeuropathy is a rare condition, and the exact pathophysiologic mechanism of nerve involvement and treatment for neurologic deficits remain unclear. The histologic findings in the present case support the possibility that the peripheral neuropathy related to LV was primarily derived from an ischemic injury rather than inflammation. Continuous anticoagulant use could be helpful in the neurologic recovery of LV patients with multiple mononeuropathy.

Abstract

This report describes a rare case of livedoid vasculopathy (LV) with sensory and motor neurologic deficits. A 46-year-old woman who had been diagnosed with LV developed acute left-foot drop. An electrodiagnostic study showed multiple mononeuropathy involving both the common peroneal and sural nerves, primarily on the left side. Nerve biopsy findings showed intravascular thrombosis in the perineurium and extensive infarct of the peripheral nerve. The patient was prescribed continuous anticoagulants, which resulted in a good clinical outcome. LV associated with multiple mononeuropathy is a rare condition, and the exact pathophysiologic mechanism of nerve involvement and treatment for neurologic deficits remain unclear. The histologic findings in the present case support the possibility that the peripheral neuropathy related to LV was primarily derived from an ischemic injury rather than inflammation. Continuous anticoagulant use could be helpful in the neurologic recovery of LV patients with multiple mononeuropathy.

참고문헌 (9)

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  3. 김지은, "Ischemic Neuropathy Associated with Livedoid Vasculitis", Journal of Clinical Neurology, 7(4), pp.233~326 (2011), 대한신경과학회
  4. Malaguti MC, "Mononeuritis multiplex associated with primary livedoid vasculopathy : neuropathological evidence of ischemic nerve damage", J Neurol Sci, 351, pp.214~215 (2015)
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  6. Pai BS, "Livedoid vasculopathy and mononeuritis multiplex, with a fulminant hepatic failure which was caused by herpes simplex hepatitis : a case report", J Clin Diagn Res, 7, pp.921~923 (2013)
  7. Toth C, "Mononeuropathy multiplex in association with livedoid vasculitis", Muscle Nerve, 28, pp.634~639 (2003)
  8. Tubone MQ, "Maldonado G : Livedoid vasculopathy associated with peripheral neuropathy : a report of two cases", An Bras Dermatol, 88(6 Suppl 1), pp.227~229 (2013)
  9. Micieli R, "Treatment for livedoid vasculopathy : a systematic review", JAMA Dermatol, 154, pp.193~202 (2018)

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