A Case of Tuberculosis-related Leukocytoclastic Vasculitis Presenting With Peripheral Neuropathy

Abstract

Tuberculous granulomatous vasculitis is commonly associated with meningitis and retinitis. We describe a 39-year-old male, with a history of pulmonary tuberculosis (TB) who presented with progressive weakness, pain, tingling and numbness in the bilateral lower extremities. Significant atrophy and weakness of the lower extremities were evident along with absent reflexes. Nerve conduction studies and electromyography showed severe axonal polyneuropathy and denervation on the lower extremities. Nerve biopsy demonstrated small vessel leukocytoclastic vasculitis without any granuloma formation. Muscle biopsy was consistent with denervation and atrophy with target fiber changes. Tuberculosis-related vasculitis causing peripheral neuropathy is extremely rare and our case is unique in manifesting this presentation.

Keywords: allergic vasculitis; leukocytoclastic vasculitis; neuropathy; tuberculosis.

Figure 1. Peripheral nerve biopsy (paraffin hematoxylin & eosin X10)

Leukocytoclastic vasculitis with obliteration of vessel wall by leukocytes and eosinophils (white arrows)

Figure 2. Peripheral nerve (methylene blue stained one micron resin section X 4)

Portions of three fascicles with myelinated fiber loss and active degeneration/demyelination