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Myelin-associated glycoprotein-related neuropathy associated with psoriasis: a case report.

Murata KY, Miwa H, Kondo T - J Med Case Rep (2013)

Bottom Line: A myelin-associated glycoprotein western blot analysis showed the presence of a 91 to 94kDa band using purified human myelin-associated glycoprotein antigen.Five days after intravenous immunoglobulin therapy, his deep sensory impairment began to improve and his sternocostoclavicular pain diminished dramatically.Because myelin-associated glycoprotein-related neuropathy and psoriatic arthritis are both considered autoimmune diseases, we conclude that intravenous immunoglobulin therapy is very effective for patients with an association of these diseases.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan. kemurata@wakayama-med.ac.jp.

ABSTRACT

Introduction: Psoriasis vulgaris is a common inflammatory disease of the skin, and myelin-associated glycoprotein-related neuropathy is a chronic sensory-predominant polyneuropathy. Although both of these diseases are considered autoimmune diseases, psoriasis with concomitant myelin-associated glycoprotein-related neuropathy is very rare. Here, we report a case of myelin-associated glycoprotein-related neuropathy associated with psoriasis.

Case presentation: A 66-year-old Japanese man, having experienced sternocostoclavicular pain for ten years, was admitted to our hospital because of gait disturbance and numbness of the limbs. Our patient had normal cranial nerve function and normal limb muscle strength. His vibratory and position sense was severely impaired and his touch, temperature and pinprick sensations were mildly disturbed in a glove and stocking distribution. A myelin-associated glycoprotein western blot analysis showed the presence of a 91 to 94kDa band using purified human myelin-associated glycoprotein antigen. His skin lesions were moderately pruritic and Auspitz's sign was positive. Our patient also showed osteitis of his clavicle and manubrium. We diagnosed our patient with myelin-associated glycoprotein-related neuropathy associated with psoriatic arthritis. Five days after intravenous immunoglobulin therapy, his deep sensory impairment began to improve and his sternocostoclavicular pain diminished dramatically.

Conclusions: Because myelin-associated glycoprotein-related neuropathy and psoriatic arthritis are both considered autoimmune diseases, we conclude that intravenous immunoglobulin therapy is very effective for patients with an association of these diseases.

No MeSH data available.


Related in: MedlinePlus

Light micrograph of a sural nerve biopsy and a bone scintigram. Light micrograph of a sural nerve biopsy showing a moderate reduction in the density of large myelinated fibers, with (A) abnormally thin myelin relative to axonal caliber (arrows) in a cross section (bar=30μm) and (B) teased fibers with short, thinly myelinated internodes (arrows), indicating remyelination (bar=100μm). (C) A bone scintigram showing an abnormal accumulation of 99mTc in both of the sternocostoclavicular joints and the right clavicular region.
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Figure 2: Light micrograph of a sural nerve biopsy and a bone scintigram. Light micrograph of a sural nerve biopsy showing a moderate reduction in the density of large myelinated fibers, with (A) abnormally thin myelin relative to axonal caliber (arrows) in a cross section (bar=30μm) and (B) teased fibers with short, thinly myelinated internodes (arrows), indicating remyelination (bar=100μm). (C) A bone scintigram showing an abnormal accumulation of 99mTc in both of the sternocostoclavicular joints and the right clavicular region.

Mentions: Motor conduction studies showed a reduced velocity in his ulnar nerve (30m/s; normal range, >50m/s) and no compound muscle action potential from his extensor digitorum brevis muscle after peroneal nerve stimulation. Sensory nerve action potentials could not be detected in either upper or lower limbs. A sural nerve biopsy showed a moderate reduction in density of large myelinated fibers (Figure 2A), with remyelinated fibers comprising 21.8% of all teased fibers (Figure 2B). His sternocostoclavicular joints and right clavicular region showed active uptake of the radioisotope 99mTc, consistent with osteitis of the clavicle and manubrium (Figure 2C).


Myelin-associated glycoprotein-related neuropathy associated with psoriasis: a case report.

Murata KY, Miwa H, Kondo T - J Med Case Rep (2013)

Light micrograph of a sural nerve biopsy and a bone scintigram. Light micrograph of a sural nerve biopsy showing a moderate reduction in the density of large myelinated fibers, with (A) abnormally thin myelin relative to axonal caliber (arrows) in a cross section (bar=30μm) and (B) teased fibers with short, thinly myelinated internodes (arrows), indicating remyelination (bar=100μm). (C) A bone scintigram showing an abnormal accumulation of 99mTc in both of the sternocostoclavicular joints and the right clavicular region.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539948&req=5

Figure 2: Light micrograph of a sural nerve biopsy and a bone scintigram. Light micrograph of a sural nerve biopsy showing a moderate reduction in the density of large myelinated fibers, with (A) abnormally thin myelin relative to axonal caliber (arrows) in a cross section (bar=30μm) and (B) teased fibers with short, thinly myelinated internodes (arrows), indicating remyelination (bar=100μm). (C) A bone scintigram showing an abnormal accumulation of 99mTc in both of the sternocostoclavicular joints and the right clavicular region.
Mentions: Motor conduction studies showed a reduced velocity in his ulnar nerve (30m/s; normal range, >50m/s) and no compound muscle action potential from his extensor digitorum brevis muscle after peroneal nerve stimulation. Sensory nerve action potentials could not be detected in either upper or lower limbs. A sural nerve biopsy showed a moderate reduction in density of large myelinated fibers (Figure 2A), with remyelinated fibers comprising 21.8% of all teased fibers (Figure 2B). His sternocostoclavicular joints and right clavicular region showed active uptake of the radioisotope 99mTc, consistent with osteitis of the clavicle and manubrium (Figure 2C).

Bottom Line: A myelin-associated glycoprotein western blot analysis showed the presence of a 91 to 94kDa band using purified human myelin-associated glycoprotein antigen.Five days after intravenous immunoglobulin therapy, his deep sensory impairment began to improve and his sternocostoclavicular pain diminished dramatically.Because myelin-associated glycoprotein-related neuropathy and psoriatic arthritis are both considered autoimmune diseases, we conclude that intravenous immunoglobulin therapy is very effective for patients with an association of these diseases.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan. kemurata@wakayama-med.ac.jp.

ABSTRACT

Introduction: Psoriasis vulgaris is a common inflammatory disease of the skin, and myelin-associated glycoprotein-related neuropathy is a chronic sensory-predominant polyneuropathy. Although both of these diseases are considered autoimmune diseases, psoriasis with concomitant myelin-associated glycoprotein-related neuropathy is very rare. Here, we report a case of myelin-associated glycoprotein-related neuropathy associated with psoriasis.

Case presentation: A 66-year-old Japanese man, having experienced sternocostoclavicular pain for ten years, was admitted to our hospital because of gait disturbance and numbness of the limbs. Our patient had normal cranial nerve function and normal limb muscle strength. His vibratory and position sense was severely impaired and his touch, temperature and pinprick sensations were mildly disturbed in a glove and stocking distribution. A myelin-associated glycoprotein western blot analysis showed the presence of a 91 to 94kDa band using purified human myelin-associated glycoprotein antigen. His skin lesions were moderately pruritic and Auspitz's sign was positive. Our patient also showed osteitis of his clavicle and manubrium. We diagnosed our patient with myelin-associated glycoprotein-related neuropathy associated with psoriatic arthritis. Five days after intravenous immunoglobulin therapy, his deep sensory impairment began to improve and his sternocostoclavicular pain diminished dramatically.

Conclusions: Because myelin-associated glycoprotein-related neuropathy and psoriatic arthritis are both considered autoimmune diseases, we conclude that intravenous immunoglobulin therapy is very effective for patients with an association of these diseases.

No MeSH data available.


Related in: MedlinePlus