Abnormal vascular smooth muscle cell proliferation in sural nerve biopsy from a patient with sensorimotor axonal neuropathy.

摘要

We report the case of a 75-year-old patient who was admitted to our department to investigate progressive weakness in his lower limbs associated with distal paraesthesias with a glove and stocking distribution. One year earlier he had been diagnosed with colon cancer with a liver metastasis and had undergone successful surgery followed by adjuvant chemotherapy (5-FU and oxaliplatin). Neurological examination revealed impaired strength in both lower limbs, graded 4 on the Medical Research Council scale in the proximal muscles and 3 in the distal ones; tendon reflexes at the knees and ankles were absent. There were no signs of upper motor neuron impairment. No abnormality was revealed on extensive laboratory studies, including complete blood count, erythrocyte sedimentation rate, immuno-fixation electrophoresis, concentrations of electrolytes, CRP, creatine kinase, FT3, FT4, thyroid-stimulating hormone, hepatic enzymes, creatinine, urine analysis and screening for infections, malignancies, malabsorption and systemic autoimmune disorders.