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Painful vasculitic neuropathy in HIV-1 infection

Relief of pain with prednisone therapy

From the Department of Neurology, University of Miami School of Medicine, and Miami VA Medical Center, Miami, FL.
Supported in part by NIH Grant NS 31488 and a VA Fellowship in Neuroscience and Neurotrauma held by Dr. Verma.
Received March 12, 1996. Accepted in final form May 2, 1996.
Address correspondence and reprint requests to Dr. Walter G. Bradley, Department of Neurology, University of Miami School of Medicine (D4-5), P.O. Box 016960, Miami, FL 33136.

Painful distal sensory polyneuropathy (DSP) is the most common peripheral neuropathy in patients with human immunodeficiency virus-1 (HIV-1) infection. There is no specific therapy for DSP, and nonspecific treatment with pain blockers and narcotic agents generally fails to adequately control the symptoms. We report two patients who had subacute painful neuropathy in the B2 (formerly AIDS-related complex [ARC]) stage of HIV-1 infection. Neurophysiologic studies revealed predominantly axonal sensorimotor neuropathy. Sural nerve biopsy in both cases showed a necrotizing vasculitis. Treatment with corticosteroids resulted in rapid relief of pain, followed by arrest of the neuropathic process. Although not previously emphasized, vasculitic neuropathy must be considered among the treatable causes of painful sensory neuropathy in HIV-1-infected individuals.

NEUROLOGY 1996;47: 1446-1451

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