Proximal diabetic neuropathy presenting with respiratory weakness.

Area of Science:

• Neurology
• Pulmonology
• Diabetology

Background:

• Diabetic neuropathy is a common complication of diabetes mellitus.
• Neuromuscular respiratory weakness can arise from various conditions, impacting diaphragm and intercostal muscle function.
• Proximal diabetic neuropathy, affecting muscles closer to the body's core, is less commonly associated with respiratory compromise.

Observation:

• A 50-year-old male patient presented with progressive shortness of breath over two months.
• The patient also exhibited proximal muscle weakness, specifically affecting hip flexion.
• Electrophysiological studies revealed absent phrenic nerve responses and abnormal activity in other respiratory muscles.

Findings:

• Electromyography showed spontaneous activity in intercostal and lumbar paraspinal muscles.
• Motor unit potentials (MUPs) in the diaphragm were of long duration with reduced recruitment, indicating significant neuromuscular impairment.
• Despite the absence of specific treatment, the patient experienced spontaneous improvement in both respiratory function and proximal leg strength.

Implications:

• This case highlights proximal diabetic neuropathy as a potential cause of neuromuscular respiratory weakness.
• The findings suggest that respiratory muscle involvement can occur in proximal diabetic neuropathy.
• Understanding this association is crucial for diagnosing and managing respiratory complications in diabetic patients.