PMC6830207_01
Left sural nerve.. Small muscular arteries showing chronic inflammatory cells in the wall and fibrin deposition.
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SPEP. A non-contrast MRI of the lumbar spine was unremarkable. She had elevated RF (585 IU/mL) with normal C3 (133.2 mg/dl) and low C4 (8.4 mg/dl). Left Sural nerve biopsy revealed vasculitis (Figure 1), confirming the diagnosis of mononeuritis multiplex due to rheumatoid vasculitis. She was treated with methylprednisone 1 gram daily for 3 days followed by a prednisone taper.