Mononeuritis multiplex

The basis for prevention of recurrence of MNM is by treating the underlying disorder. If the underlying condition stabilises or resolves, immunosuppression may be lowered or discontinued in select cases.

Measures can also be taken to prevent complications from treatment:

• H₂ antagonists or proton-pump inhibitors are recommended while on corticosteroid therapy if the patient has a history of peptic or duodenal ulcer disease.

• Bisphosphonates should be considered for the prevention of corticosteroid-induced osteoporosis in people receiving corticosteroids for ≥3 months. See Osteoporosis (Prevention).

• Patients with a history of tuberculosis or a positive purified protein derivative (PPD) result may need prophylactic treatment with isoniazid.

• If given intravenously, cyclophosphamide should be administered with mesna and fluids before and after administration to minimise the risk of haemorrhagic cystitis.

• Neutropenic precautions and Pneumocystis jiroveci prophylaxis are appropriate.

• Influenza and pneumococcal vaccines should be given, but no live vaccines should be administered.[1]Collins MP, Kissel JT. Neuropathies with systemic vasculitis. In: Dyck PJ, Thomas PK, eds. Peripheral neuropathy. 4th ed. Vol. 2. Philadelphia, PA: Elsevier Saunders; 2005:2335-2404. https://www.sciencedirect.com/science/article/abs/pii/B9780721694917501083