I read with much interest the article by Kafka et al1 that appeared in the June issue of the Archives. However, their three patients with mononeuritis multiplex and anti—neutrophil cytoplasmic autoantibody positivity are not the first to be described. As a matter of fact, our group2 reported a singular case in which histologic findings on muscular biopsy material were compatible with vasculitis. Interestingly, our patient was also found to have suffered from Lyme disease with lymphocyte meningitis and cerebral vasculitis; this latter, however, continued to be symptomatic, while the patient was treated with adequate antibiotic therapy, and then with immunosuppressive therapy (cyclophosphamide). This treatment appeared clinically successful after 2 years of follow-up, although the test for anti—neutrophil cytoplasmic autoantibody, which initially had shown negative results, yielded positive results when repeated. So, I do share the opinion of the authors when they state that "detection of ANCAS [anti-neutrophilic cytoplasmic
Delpla PA. Multiple Mononeuropathy and Anti-Neutrophil Cytoplasmic Autoantibody. Arch Neurol. 1995;52(5):443. doi:10.1001/archneur.1995.00540290021006
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