Hypertrophic neuropathy with diabetes mellitus

Area of Science:

• Neurology
• Diabetology
• Pathology

Background:

• Diabetic neuropathy is a common complication of diabetes mellitus.
• It typically presents as sensorimotor disturbances.

Observation:

• A 52-year-old male with diabetes presented with glove and stocking distribution sensorimotor disturbance.
• Electromyography showed denervation, with unobtainable motor nerve conduction velocities.
• Sural nerve biopsy revealed decreased myelinated and unmyelinated fibers and increased onion bulb formations.

Findings:

• The patient exhibited severe peripheral neuropathy with significant fiber loss.
• Unusual and extensive onion bulb formations were noted, a rare finding in diabetic neuropathy.
• The case was non-familial, suggesting an atypical presentation.

Implications:

• This case highlights the diverse pathological spectrum of diabetic neuropathy.
• It suggests that hypertrophic changes like onion bulb formations can occur in non-hereditary diabetic neuropathy.
• Further research may be needed to understand atypical forms of diabetic neuropathy.