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Mononeuritis multiplex in diabetes mellitus: evidence for underlying immune pathogenesis
1Department of Neurology, University of Iowa, Iowa City, Iowa, USA. praful-kelkar@uiowa.edu
Journal of Neurology, Neurosurgery, and Psychiatry
|May 20, 2003
Summary
Diabetic mononeuritis multiplex, a nerve condition in type 2 diabetes, may stem from immune-mediated vasculopathy. Immunotherapy showed promise in improving symptoms for most patients.
Area of Science:
- Neurology
- Immunology
- Diabetology
Background:
- Type 2 diabetes mellitus is a complex metabolic disorder.
- Diabetic amyotrophy is a recognized complication, but other neuropathies are less understood.
- Mononeuritis multiplex presents as subacute neurological deficits.
Observation:
- Four patients with type 2 diabetes mellitus presented with subacute mononeuritis multiplex.
- Sural nerve biopsies revealed multifocal axonal loss.
- Epineurial perivascular inflammation of small vessels was noted in three patients.
Findings:
- The neuropathological findings suggest an inflammatory process targeting small blood vessels within nerves.
- The presence of inflammation points towards an immune-mediated mechanism.
- The subacute onset and specific nerve involvement characterize this presentation.
Implications:
- Mononeuritis multiplex in diabetes may be an immune-mediated vasculopathy.
- This condition could be pathogenetically related to diabetic amyotrophy.
- Further research into immune-mediated mechanisms in diabetic neuropathy is warranted, and immunotherapy may be a viable treatment option.
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