In the November 1995 Archives, Krendel et al1 presented data about 15 patients with diabetes whose neuropathies improved with immunotherapy. These findings are exciting and add to the growing literature about immunotherapy for patients with disabling diabetic neuropathies.2,3 They proposed that some such patients have an axonal inflammatory vasculopathy mimicking proximal diabetic neuropathy (PDN) or a syndrome indistinguishable from chronic inflammatory demyelinating polyneuropathy (CIDP) and may be distinct from other patients with diabetes with clinically similar conditions that are not immune-mediated. This is a valid hypothesis but it is not well-supported by their data. I present a similar case, comment on the conclusions drawn by Krendel et al, and suggest ways to address the important questions that they have raised.
Report of a Case.
A progressive, painful, asymmetric proximal lower limb paresis that spared the upper extremities developed in a 67-year-old with insulin-dependent diabetes. Electrodiagnostic studies demonstrated a
Walk D. Immunotherapy of Neuropathies in Patients With Diabetes Mellitus Requires Closer Scrutiny. Arch Neurol. 1996;53(7):590–591. doi:10.1001/archneur.1996.00550070020006
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