Ultrasonographic imaging of the peripheral nerves in a Wegener granulomatosis patient with multiple mononeuropathies.

To the Editor, A 70-year-old man (with a diagnosis of Wegener Granulomatosis (WG)) was seen for weakness in his hands and feet predominantly on the right side. His complaints had started with a right-sided paresthesia and drop foot 6 months ago, and laboratory studies (at that time) had been as follows – erythrocyte sedimentation rate: 84 mm/h (0-20 mm/h), C-reactive protein: 47.6 mg/l (0-3 mg/l), perinuclear anti-nuclear cytoplasmic antibody (p-ANCA): positive, cytoplasmic ANCA (c-ANCA): negative. Skin biopsy was compatible with the diagnosis of WG. The patient had been under pulse cyclophopsphamide and daily prednisolone treatment since then. His medical history was unremarkable except for chronic bronchitis. In physical examination, the patient was observed to ambulate using a cane with small steps. In addition, there were thenar and interosseous muscles atrophies in right hand. Neurological examination revealed asymmetric motor weakness in the upper and lower extremities, predominantly in the distal muscles groups: right thumb flexion/palmar abduction and second finger flexion (0/5), right ankle/toes dorsiflexion (3/5) and right ankle eversion (2/5), left hand intrinsic muscles (4/5) and left ankle dorsiflexion and eversion (4/5). Sensory testing displayed hypoesthesia on the right-sided median, ulnar and sural sensory nerves’ distribution. All deep tendon reflexes were diminished and pa thological reflexes were absent. Nerve conduction studies showed absence of right-sided median nerve sensory-motor and ulnar nerve sensory amplitudes. Ulnar, tibial and peroneal nerve Murat Kara1, Tülay Tiftik1, Arif Kaya2, Fatih Sarı1, Sumru Özel1, Levent Özçakar3