Abstract
A 47-year-old man with a 20 year history of obesity and hypertension was referred to us because of a 2 month history of pain in the left lateral thoracic area. His height was 162cm, weight 80kg. He had poorly controlled NIDDM (HbA1c 8.7%) with retinopathy (Scott Illb), incipient nephropathy and a mild degree of peripheral and autonomic neuropathies. His blood sugar became well controlled by diet alone but his pain continued with a noctural exacerbation. Chest and abdominal examinations including coronary angiogram and myelogram didn't reveal any cause of his pain. 7 months after the onset, he noticed a bulge in his left hypochondrium compatible with the anterior distribution of the 8th thoracic spinal nerve, the same area where he had pain. An electromyogram and muscle biopsy from the swollen area revealed a neurogenic pattern of muscle degeneration. His cerebrospinal fluid showed a moderate increase in protein content. His pain and swelling spontaneously disappeared 13 months after onset.
Our case is compatible with diabetic truncal mononeuropathy (DTM) involving not only sensory, but also motor nerves. This is the first report of this type of DTM in Japan to our knowledge.
