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|LETTER TO EDITOR
|Year : 2019 | Volume
| Issue : 6 | Page : 1565
A Relapsing Chronic Inflammatory Demyelinating Polyneuropathy Preceding Type I Diabetes in a Young Male
Mansour Malek1, Souissi Wala1, Kacem Wafa2, Riahi Anis1, Mrissa Ridha1
1 Department of Neurology, Military Hospital of Tunis, Tunisia
2 Department of Physiology, Faculty of Medicine of Tunis, Tunisia
|Date of Web Publication||20-Dec-2019|
Dr. Souissi Wala
Department of Neurology, Military Hospital of Tunis
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Malek M, Wala S, Wafa K, Anis R, Ridha M. A Relapsing Chronic Inflammatory Demyelinating Polyneuropathy Preceding Type I Diabetes in a Young Male. Neurol India 2019;67:1565
|How to cite this URL:|
Malek M, Wala S, Wafa K, Anis R, Ridha M. A Relapsing Chronic Inflammatory Demyelinating Polyneuropathy Preceding Type I Diabetes in a Young Male. Neurol India [serial online] 2019 [cited 2020 Apr 2];67:1565. Available from: http://www.neurologyindia.com/text.asp?2019/67/6/1565/273652
Chronic inflammatory demyelinating polyradiculopathy (CIDP) is considered as an autoimmune disorder of unknown etiology. However, some systemic disorders such as type 1 diabetes mellitus (T1DM) can be associated with its presentation.
A 17-year-old male with no medical history was referred to our institution in November 2014 with complaints of progressive difficulty with gait that had been worsening gradually over five months. Neurological examination revealed areflexia, severe muscle weakness (modified Medical Research Council sum score 12 out of 45), and sensory impairment of the four limbs [Immune Neuropathies Cause and Treatment (INCAT) sensory sum score (ISS) 10 out of 20]. Electrophysiology study (EMG) findings were consistent with CIDP. His blood glucose level and hemoglobin A1c (HbA1c) were high (2g/dl and 12.9%, respectively). Auto antibody tests showed a positive range of anti- GAD, confirming a T1DM. A previous blood glucose level test done one month before his hospitalization was normal. The patient received steroids with a significant improvement. His diabetes was well-controlled on insulin. In April 2017, weakness of his left lower limb recurred. He received oral prednisolone. Within a month, he was able to walk without assistance.
This report shows a rare case of CIDP preceding few months of T1DM. CIDP is frequent in patients suffering from diabetes but affects them after severe years of diabetes. As for this patient, he developed T1DM after CIDP because he was totally asymptomatic of T1DM with a normal blood glycemic level when he first had neurological symptoms. The mechanism underlying the association of type 1 diabetes and CIDP is still debated. Some have hypothesized the existence of common autoantigen in peri-islet Schwann cells and peripheral nerve Schwann cells. In countries where IVIg has limited availability due to its high costs such as Tunisia or when plasmapheresis can be invasive, steroids can be the best therapeutic option. The reason for this preference, apart from substantially lower costs, is the family's assistance that ensures a good diabetes control. The diagnosis of T1DM should be considered in each patient, especially among children and teenagers presenting CIDP even in the absence of general manifestation.
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