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Vasculitic neuropathy — SCE Neurology MCQ

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ModerateNeuromuscularVasculitic neuropathySCE Neurology

A 42-year-old woman presented with painful foot drop followed by wrist drop over weeks. On examination, there was asymmetric sensory loss and livedo reticularis. Initial investigations showed: NCS showed axonal mononeuritis multiplex; ESR and ANCA were raised. What is the most appropriate management?

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Correct answer: D — Disease-specific immunotherapy or supportive respiratory monitoring

Disease-specific immunotherapy or supportive respiratory monitoring is the best answer because the vignette describes Vasculitic neuropathy: painful asymmetric axonal neuropathy indicates vasculitic mononeuritis multiplex. Empirical intravenous ceftriaxone after blood cultures is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. High-dose intravenous methylprednisolone after excluding infection and Intravenous immunoglobulin with respiratory monitoring are less appropriate because they would require different localisation, timing or test findings; Multidisciplinary rehabilitation with goal-setting would fit a different syndrome. Clinical pearl: CIDP is usually symmetric demyelinating with proximal and distal weakness.

Reference: NICE NG42; ABN myasthenia gravis guidance; EAN/PNS GBS-CIDP guidance