Walk describes another patient with a clinical syndrome consistent with PDN who improved after receiving IV immune globulin. This is encouraging and supports our impression that IV immune globulin can be an effective treatment in these patients.1The questions raised by Walk are important, and I appreciate the opportunity to offer my views.• Do patients with diabetes and treatable neuropathies represent subsets of PDN and DDSPN with an unusually prominent secondary inflammatory response, or do they represent a distinct disease or group of diseases?In my view, these explanations are not mutually exclusive. An unusually prominent secondary inflammatory response that causes widespread tissue damage and responds to immunosuppressive therapy can be viewed as a distinct autoimmune disease. Perhaps exposure of peripheral nerve antigens to the immune system predisposes patients with DDSPN to CIDP. Dyck et al2 proposed a similar mechanism for prednisone-responsive neuropathy in patients
Krendel DA. Immunotherapy of Neuropathies in Patients With Diabetes Mellitus Requires Closer Scrutiny-Reply. Arch Neurol. 1996;53(7):591–592. doi:10.1001/archneur.1996.00550070020007
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