RESUMO
OBJECTIVE: Small fiber neuropathy commonly affects patients with sarcoidosis and is often refractory to standard immunosuppressive therapies used for systemic disease. The clinical features of sarcoidosis-associated small fiber neuropathy (SSFN) and its response to medical therapy have not been described in a large population. METHODS: We performed a retrospective review of patients with SSFN seen at the Cleveland Clinic over a 4-year period. RESULTS: SSFN was identified in 143 individuals although other causes of neuropathy were found in 28 cases. Of the remaining 115 patients, 100 (87%) were Caucasian and 72 (63%) were female. Median age at reported neuropathy onset was 46 years (range 19-77 years), while median age of systemic diagnosis was 41 years. Pain and paresthesias were the most common symptoms, of which 54% were nonlength-dependent. Dysautonomia was seen in 61 patients with cardiac symptoms (orthostasis, palpitations) as the most common presentation followed by gastrointestinal and sweating dysfunction. Symptomatic improvement with treatment was seen in 47 of 62 patients that received IVIG, 8 of 12 patients that received anti-TNF and 10 of 14 patients who received combination therapy. Of 27 patients who were untreated, 4 improved. CONCLUSIONS: The most common presentation of SSFN in our series was a painful non-length dependent polyneuropathy with the highest overall incidence in Caucasian females. In most patients, neuropathy symptoms developed within 3 years of systemic sarcoidosis diagnosis. IVIG appeared beneficial in treating SSFN symptoms while nearly 2/3 of subjects also responded favorably to anti-TNF with or without IVIG. Further prospective studies are needed.
Assuntos
Imunoglobulinas Intravenosas/toxicidade , Sarcoidose/diagnóstico , Neuropatia de Pequenas Fibras/tratamento farmacológico , Neuropatia de Pequenas Fibras/fisiopatologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Idoso , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Sarcoidose/sangue , Sarcoidose/complicações , Sarcoidose/tratamento farmacológico , Neuropatia de Pequenas Fibras/complicações , Neuropatia de Pequenas Fibras/patologia , Fator de Necrose Tumoral alfa/uso terapêutico , População Branca/etnologia , População Branca/estatística & dados numéricosAssuntos
Eletrodiagnóstico/métodos , Paralisia Facial/etiologia , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/diagnóstico , Oftalmoplegia/etiologia , Reflexo Anormal , Tomada de Decisão Clínica , Diagnóstico Diferencial , Eletromiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Miller Fisher/complicações , Síndrome de Miller Fisher/diagnóstico , Condução Nervosa/fisiologiaRESUMO
Compression of the lateral femoral cutaneous nerve (LFCN) in the thigh, commonly referred to as meralgia paresthetica, may be due to obesity, tight clothing and other external factors. We report two cases of meralgia paresthetica due to compression of the LFCN by portable electronic or "smart" devices.
