Vasculitis in the inflammatory neuropathy due to infectious agents

Leprous neuropathy

Non-necrotizing lymphocytic vasculitis is observed in the different patterns of leprous neuropathy, including lepromatous, tuberculoid and type 1 and type 2 reversal reactions. In lepromatous leprosy, vasculitis is associated with infection of endothelial cells by Mycobacterium leprae. A role for ischemia is likely in some reverse reactions during treatment of lepromatous leprosy and borderline lepromatous neuropathy.68

Vasculitis in HIV infection

In the course of HIV infection, different patterns of lymphocytic vasculitis are observed, in association with the various types of inflammatory neuropathy encountered in this setting.68 Clinically, the usual pattern of neuropathy associated with prominent vasculitis is that of a subacute, multifocal, often bilateral, mixed, motor and sensory deficit associated with polyclonal hypergammaglobulinemia, and increased protein content and pleocytosis in the CSF. The most common type of lymphocytic vasculitis is just an exaggerated inflammatory infiltrate that invades the vessel wall without causing more damage. In a few instances, the pattern is that of an angiocentric lymphocytic proliferation associated or not with necrosis of the vessel wall. In such cases, axonal degeneration of nerve fibers is ssociated with a large proportion of demyelinated fibers.

NA of the type observed in PAN, with fibrinoid necrosis and leukocytoclasia, is also observed in HIV neuropathy.67,69 In this setting, however, in contrast with the usual pattern of lesions observed in PAN, mononuclear cells predominate in the inflammatory infiltrate, which is often present in the endoneural space, and affect small endoneural blood vessels. The lesions of nerve fibers observed in this setting often included a higher than usual proportion of demyelinated fibers in a series of patients with necrotizing vasculitis and HIV infection. Additionally, inflammatory myopathy and lesions of muscle arteries are often present. At late stages of the immunosuppression induced by HIV infection, opportunistic infection of nerve blood vessels, especially of endothelial cells of endoneural capillaries by cytomegalovirus, can further damage nerves.

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