While thrombotic microangiopathy (TMA) can commonly affect the kidney, peripheral nerve involvement has not been reported to date. A 56-year-old man, recipient of a kidney allograft, reported severe headaches, tremors, and diarrhea followed by sudden-onset right foot drop after increasing his dose of tacrolimus. He then developed acute right hand pain, numbness, and weakness. At presentation, neurological examination and electroneuromyography confirmed the presence of right worse than left, sciatic and ulnar mononeuropathies. Kidney biopsy showed evidence of a thrombotic microangiopathy. Similarly, nerve biopsy showed thrombosis of epineurial blood vessels with minimal inflammation. Herein, we demonstrated that thrombotic microangiopathy can involve the peripheral nerves, resulting in major morbidity. Distinguishing TMA from vasculitis is important because it has major treatment implications.

中文翻译：

---

涉及肾同种异体移植物和周围神经的血栓性微血管病。

虽然血栓性微血管病 (TMA) 通常会影响肾脏，但迄今为止尚未报告周围神经受累。一名接受同种异体肾移植的 56 岁男性报告说，在增加他克莫司的剂量后，出现严重的头痛、震颤和腹泻，随后右脚突然下垂。然后，他出现了急性右手疼痛、麻木和无力。就诊时，神经系统检查和神经肌电图证实存在右侧比左侧更严重的坐骨神经和尺骨单神经病。肾活检显示血栓性微血管病的证据。同样，神经活检显示神经外膜血管血栓形成，炎症极少。在此，我们证明血栓性微血管病可累及周围神经，导致严重的并发症。