Lesson of the month
Joint and muscle pain with mononeuritis multiplex, tetraparesis, and myocardial infarction in a previously healthy adult
A D Wagnera, T Feista, R Prondzinskyb, W E Fleiga, G Key
era
a Department
of Internal Medicine I, Martin-Luther- University Halle-Wittenberg,
Germany, b Department of Internal Medicine III,
Martin-Luther- University Halle-Wittenberg, Germany
Correspondence to: Dr A D Wagner, Martin-Luther-University Halle-Wittenberg, Department of Internal Medicine I, Ernst Grube-Str 40, 06097 Halle/Saale, Germany anna-dorothea.wagner@gmx.de
Accepted for publication 7 June 2001
| The first 150 words of the full text of this article appear below. |
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Case report |
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A 49 year old man presented with a three months' history of symmetrical joint and muscle pain, starting in the elbow region with further extension to the whole body, and weight loss of 11 kg within four months. Laboratory investigation showed an erythrocyte sedimentation rate (ESR) of 100 mm/1st h, leucocytosis of 20.6×109/l, and a massively raised rheumatoid factor. Creatine kinase (CK) and antineutrophil cytoplasmic antibodies (ANCA) were normal. The patient had pain in elbow, wrist, knee, and ankle regions, though no joint swelling was seen. Rheumatoid arthritis was suspected and treatment with steroids and methotrexate was started. Four weeks later, an ascending numbness of the extremities occurred, starting in the left foot and subsequently spreading to both lower legs and forearms. This was accompanied by a progressive muscle weakness. The patient was then referred to our institution.
On admission, the patient presented with a temperature of 38.6°C,
severely reduced general
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