Necrotising vasculitis is one of the pathological findings of mononeuropathy multiplex in patients infected with HIV. It is an infrequent complication that can occur at different stages of immunosuppression and with a prognosis correlating with the degree of immunocompetence.1-4 We report a patient with AIDS affected by necrotising vasculitis, who was successfully treated and followed up for 19 months.

A 35 year old woman with AIDS presented in February 1995 with a two week history of progressive weakness and pain of her right hand and a left foot drop. The patient had been followed up neurologically since March 1994 for a distal sensory neuropathy, confirmed by electrophysiological studies. Her distal sensory neuropathy involved the lower limbs and was thought to be a result of HIV infection but exacerbated by zalcitabine and didanosine.

Her medical history included recurrent pneumonia, syphilis, gonorrhoea, oral candidiasis, and Clostridium difficile colitis. Severe headaches had been evaluated in May 1994 with a normal MRI and lumbar puncture (venereal disease research laboratory test negative). Her CD4 count had dropped significantly from 392 to 94/mm³between February and December 1994.

In February 1995, her neurological examination showed normal cognition, language, and intact cranial nerves. Motor examination disclosed normal tone, intrinsic muscle weakness of the right hand involving muscles supplied by …