Clinical manifestations and paraclinical investigations in patients with anti-FGFR3 Abs and sensory neuropathy
Number | Sex/age | Associated context | Before neuropathy | Neuropathy onset | Clinical presentation | SNN criteria | Non-length dependent | CSF Protein/cell | Electrophysiology | Other findings |
---|---|---|---|---|---|---|---|---|---|---|
1 | M/42 | Psoriasic rheumatism, SSA and SSB antibodies | Yes | Progressive | Ataxia and lower limb areflexia | NA | NA | ND | ND | |
2 | F/33 | Systemic lupus erythematosus | Yes | Subacute | Burning and constricting pain in chest and limbs | No | Yes | ND | ND | |
3 | F/67 | Systemic lupus erythematosus | Yes | Progressive | Pain in hands and legs. Lower limb areflexia and vibration sensory loss in lower limbs | No | No | ND | ND | |
4 | F/69 | Systemic lupus erythematosus | Yes | Progressive | Ataxia, paraesthesia, pain and vibration loss in all four limbs. Lower limb areflexia | NA | Yes | ND | ND | |
5 | F/54 | Rheumatic polyarthritis, primary biliary cirrhosis, Sjögren's syndrome | Yes | Subacute | Right facial pain with allodynia and left facial paraesthesia | No | Yes | ND | ND | |
6 | F/37 | None | Progressive | Burning pain in feet. Reduced pain sensation in lower limbs | No | No | ND | ENMG normal. Abolished potentials in both feet and both hands on LEP | Reduced fibre density on skin biopsy | |
7 | F/73 | None | Progressive | Burning pain in feet and hands. Reduced pain sensation in lower limbs. Lower limb ataxia | No | Yes | ND | Reduced SAP in both feet and both hands. Normal MCV | ||
8 | M/44 | Melanoma in remission 8 years earlier | Yes | Progressive | Paraesthesia and pain and vibration sensory loss in the four limbs. Left face numbness. Asymmetrical distribution. Diffuse areflexia | Yes | Yes | ND | Abolished SAP in both feet and both hands Normal MCV | Nerve biopsy: moderate MF loss. No regenerating fibres |
9 | F/44 | HIV infection | Yes | Acute | Pain, dysesthesia, ataxia and pain and vibration sensory loss in all four limbs. Areflexia | Yes | Yes | 1.1 g/L polyclonal 27 WCC/mm3 | Reduced or abolished SAP in both feet and both hands. Normal MCV | |
10 | F/59 | Thyroid cancer in remission 5 years earlier | Yes | Subacute | Paraesthesia and pain and vibration sensory loss in all four limbs and face. Asymmetrical distribution. Diffuse areflexia | Yes | Yes | Normal | Reduced or abolished SAP in both feet and both hands. Normal MCV | Nerve biopsy: severe MF loss. No regenerating fibres |
11 | M/38 | None | Subacute | Loss of pain and thermal sensation over the whole body. Lower limb areflexia. Depressed vibration sensation | Yes | Yes | Normal | Reduced or abolished SAP in both feet and both hands. Normal MCV | Reduced fibre density on skin and nerve biopsy. No regenerating fibres | |
12 | M/18 | Sjögren's syndrome | No | Progressive | Severe sensory loss predominately in large fibres with ataxia in all four limbs. Areflexia. Abnormal pupils and sudomotor disturbances | Yes | Yes | 0.26 g/L oligoclonal 1 WCC/mm3 | Abolished SAP in both feet and both hands. Normal MCV | Nerve biopsy: MF loss. No regenerating fibres |
13 | M/58 | Sjögren's syndrome | Yes | Progressive | Severe ataxia. Sensory loss in all four limbs and left face. Areflexia | Yes | Yes | 0.80 g/L polyclonal 3 WCC/mm3 | Reduced or abolished SAP in both feet and both hands. Normal MCV | |
14 | F/51 | ANA and anticitrullin antibodies | No | Progressive | Pain in all four limbs. Dysesthesia and pain and vibration sensory loss in the left leg. Areflexia | Yes | Yes | 0.52 g/L polyclonal 1 WCC/mm3 | Reduced SAP in both feet and both hands. Normal MCV | Nerve biopsy: MF loss. No regenerating fibres |
15 | M/50 | Ulcerative rectohaemorrhagic colitis, ankylosing spondylitis | No | Acute | Severe paraesthesia and ataxia in all four limbs with pain and vibration sensory loss. Areflexia | Yes | Yes | 0.73 g/L polyclonal 1 WCC/mm3 | Abolished SAP in both feet and both hands. Normal MCV | Nerve fibre loss on skin biopsy |
16 | F/34 | None | Progressive | Electric pain and paraesthesia in the upper limbs and left leg. Pain and vibration sensory loss. Areflexia | Yes | Yes | Normal | Reduced SAP in both feet and both hands. Normal MCV | Nerve biopsy: fibre loss. Axonal degeneration. T-cells infiltration |
‘Before neuropathy’ indicates whether or not the autoimmune disease preceded the onset of neuropathy.
CSF, cerebrospinal fluid; ENMG, electroneuromyography; F, female; FGFR3, fibroblast growth factor receptor 3; LEP, laser evoked potentials; M, male; MCV, motor conduction velocities; MF, myelinated fibre; NA, not available; ND, not done; SAP, sensory action potentials; SNN, sensory neuronopathy; WCC, white cell count.