Correspondence

Case 5-1995: Arteritis with Multiple Cerebral Infarcts

N Engl J Med 1995; 333:69-70July 6, 1995

Article

To the Editor:

In his otherwise superb discussion of Case 5-1995 (Feb. 16 issue),1 Dr. Caplan was inaccurate in stating that ``lymphomatoid granulomatosis does not involve the peripheral nerves.'' In addition to causing intraparenchymal brain masses, this disorder may involve the peripheral nervous system. In the initial report of this condition, 20 percent of patients had evidence of central nervous system disease and 15 percent ``peripheral neuritis,'' and pathological studies revealed lymphocytic infiltration, often atypical, of peripheral and cranial nerves.2 In a larger study, 11 of 152 patients (7 percent) had peripheral neuropathy.3 In that study, both central nervous system involvement and peripheral nervous system involvement were poor prognostic factors. This entity should be considered in patients who have pulmonary symptoms and neuropathy, particularly with mononeuropathy multiplex.

David Schiff, M.D.
Mayo Clinic, Rochester, MN 55905

3 References

1. 1

   Case Records of the Massachusetts General Hospital (Case 5-1995). N Engl J Med 1995;332:452-459
   Full Text | Web of Science | Medline

2. 2

   Liebow AA, Carrington CR, Friedman PJ. Lymphomatoid granulomatosis. Hum Pathol 1972;3:457-558
   CrossRef | Web of Science | Medline

3. 3

   Katzenstein AA, Carrington CB, Liebow AA. Lymphomatoid granulomatosis: a clinicopathologic study of 152 cases. Cancer 1979;43:360-373
   CrossRef | Web of Science | Medline