An unusual neuropathy in a diabetic patient: evidence for intravenous immunoglobin-induced effective therapy

We report the case of a 68-year old type-2 diabetic male patient who was ad mitted to hospital for progressive weakness in the right lower limb. Althou gh his metabolic control was good, he lost more than 20 kg of weight. Despi te intensive physio- and vitamino-therapy, his neurological condition kept on degrading with a severe amyotrophy and pain of the right thigh. He was u nable to walk and to stand alone. Besides a yet known sensitive polyneuropa thy, the electrophysiological study revealed an obvious motor involvement w ith signs of demyelination and axonal degeneration. Combined with the album inocytologic dissociation observed in the cerebrospinal fluid, these specif ic clinical and electrophysiological features led us to postulate a diagnos is of inflammatory neuropathy. The patient underwent a treatment by methylp rednisolone and immunoglobins that rapidly induced a striking improvement o f his neurological condition. This case report illustrates that rare forms of neuropathy such as inflamma tory neuropathies close to chronic inflammatory demyelinating polyneuropath y(CIDP) can occur in diabetic patients and superimpose on the more commonly described farms of neuropathies. It recalls the importance of recognizing CIDP-like neuropathies because unlike other forms of neuropathy, inflammato ry neuropathies are perfectly curable.