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Mononeuritis multiplex or other?

Sean Burke12/24/20 12:32 PM (CST)

I'm seeing a 50 y/o man with painful asymmetric polyneuropathy whose exam suggests severe weakness and sensory loss involving left median and left tibial myotomes/dermatomes. Very weak DIP flexion in left hand digits 1-3 suggesting AIN involvement. Only significant past medical history includes heroin use. Negative or normal: anca, esr, crp, hiv, hep Bs Ag, hep c ab, Ana, sjogrens abs, cryoglobulins, CBC, cmp. Last reported use of heroin February 2020, symptom onset September 2020. Nerve and muscle biopsy planned. Has anyone ever seen mononeuritis multiplex without any abnormalities on the serum lab tests? NCS/EMg confirms asymmetric polyneriopathy with subacute denervation in left APB, left FCR, left gastric. Chronic denervation in left TA.

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