Obturator Nerve Dysfunction from Lymphadenopathy in Systemic Lupus Erythematosus
Overview
A 26-year-old woman with systemic lupus erythematosus (SLE) developed right thigh pain and hip movement restriction due to obturator nerve compression by lupus-related lymphadenopathy. Imaging and biopsy excluded primary myositis and malignancy, and corticosteroid therapy led to rapid clinical and radiological improvement.
Background
Systemic lupus erythematosus is an autoimmune disease with diverse manifestations including cutaneous lesions, arthritis, and lymphadenopathy. Neurological complications are varied but obturator neuropathy secondary to lymph node enlargement is rare. Differentiating this from primary muscle inflammation or malignancy is challenging but critical for appropriate management. Awareness of this mechanism facilitates interdisciplinary evaluation and timely treatment.
Data Highlights
Imaging revealed multifocal myositis-like changes in the right gluteal and thigh muscles, signal alterations in the sciatic nerve, and enlarged lymph nodes compressing the right obturator nerve. Biopsies of muscle tissue showed no myositis or neuromuscular pathology. Lymph node biopsy demonstrated reactive changes without malignancy. Corticosteroid treatment resulted in rapid symptom and lymphadenopathy resolution.
Key Findings
Obturator nerve dysfunction was caused by compression from enlarged lymph nodes related to SLE lymphadenopathy.
Initial MRI findings mimicked myositis ossificans and multifocal myositis but muscle biopsies showed no inflammatory myopathy.
Electroneurography and electromyography excluded primary nerve pathology affecting the obturator nerve.
Lymph node biopsy ruled out lymphoma, showing reactive changes and EBV positivity without malignancy.
High-dose oral prednisolone induced rapid clinical and radiological improvement, confirming SLE-related lymphadenopathy as the cause.
Clinical Implications
Clinicians should consider lymphadenopathy-induced nerve compression in SLE patients presenting with focal neuropathic symptoms and muscle changes on imaging. Differentiating this from primary myositis or malignancy requires comprehensive imaging, biopsy, and electrophysiological studies. Early corticosteroid therapy can lead to symptom resolution and prevent unnecessary interventions.
Conclusion
Obturator nerve dysfunction due to lupus-related lymphadenopathy is a rare but important differential diagnosis in SLE patients with thigh pain and muscle abnormalities. Interdisciplinary evaluation and targeted immunosuppressive treatment can achieve favorable outcomes.
References
Case Report 2023 -- Obturator Nerve Dysfunction Associated with Lymphadenopathy in Systemic Lupus Erythematosus
