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Peripheral neuropathies after arthropod stings not due to Lyme disease

A report of five cases and review of the literature

Service de Neurologie (Drs. Créange, Saint-Val, and Degos), and the Département de Pathologie (Neuropathologie) (Dr. Gherardi), Hôpital Henri Mondor, Créteil, France; and the Service de Médecine Interne (Dr. Guillevin), Hôpital Avicenne, Bobigny, France.

Five patíents developed neurologic symptoms a few hours to 2 months after being stung by a non-hooking arthropod with immediate cutaneous reaction. The patients had no clinical or serologic evidence for Lyme borreliosis and rickettsia1 disease. Clinical and electrophysiologic findings were consistent with a mixed axonal and demyelinating mononeuropathy, a monomelic multiple mononeuropathy, a mononeuropathy multiplex, a radiculoneuritis, and a distal symmetric polyneuropathy. Muscle and nerve biopsies showed lymphoplasmacytic small-vessel vasculitis in all patients, and wallerian degeneration in three. These patients, and 17 others from the literature, indicate a spectrum of peripheral neuropathies occurring after insect and spider stings.

Address correspondence and reprint requests to Dr. R.K. Gherardi, Département de Pathologie (Neuropathologie), Hôpital Henri Mondor, 94010 Créteil Cedex, France.

Received October 9, 1992. Accepted for publication in final form December 4, 1992.

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