Abstract
We describe a 47-year-old diabetic female with slowly progressive distal limb weakness and sensory impairment since age 45. Sural nerve biopsy showed severe loss of myelinated fibers with occasional fibers with thin myelin and onion bulb formations. Detailed motor nerve conduction studies revealed considerable slowing in conduction velocity with multifocal conduction block localized to sharply circumscribed areas. These results were compatible with acquired multifocal demyelinating neuropathy and seemed to be extremely exceptional in a case of diabetic polyneuropathy. Concurrence of chronic inflammatory demyelinating polyneuropathy (CIDP) was, thus, strongly suspected in this case.Corticosteroids and plasma exchange may be effective for CIDP, nevertheless no specific treatment was employed because of severely degenerative retinopathy in this case.Early diagnosis is essential to prevent the progression of axonal degeneration in CIDP. Concurrence of CIDP and diabetes may exaggerate degenerative processes in nerve fibers.
