Atypical diabetic neuropathy with poor response to usual pharmacological treatment: a case report

Hmida Yosra Ben; Chaima Jemai; Achwak Mehrez; Yasmine Fakhfekh; Syrine Trabelsi; Sami Fitouri; Imen Hedfi; Olfa Lajili; Ali Zohra Hadj; Yosra Htira; Mami Faika Ben

doi:10.1530/endoabs.99.EP1067

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Endocrine Abstracts (2024) 99 EP1067 | DOI: 10.1530/endoabs.99.EP1067

ECE2024 Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (383 abstracts)

Atypical diabetic neuropathy with poor response to usual pharmacological treatment: a case report

Yosra Ben Hmida , Chaima Jemai , Achwak Mehrez , Yasmine Fakhfekh , Syrine Trabelsi , Sami Fitouri , Imen Hedfi , Olfa Lajili , Zohra Hadj Ali , Yosra Htira & Faika Ben Mami

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National Institute of Nutrition of Tunis, C

Introduction: Diabetes is currently a worldwide pandemic. Neuropathy is Among its most disabling complications. We report the case of a patient with diabetic neuropathy with atypical presentation.

Case presentation: This is a 54-year-old patient hospitalized at department C of the National Institute of Nutrition of Tunis for uncontrolled type 2 diabetes (HbA1C=11.2%). Her diabetes has been evolving since 8 years. She was put on insulintherapy since 2 years. She was an active smoker at a rate of 50 packs a years and had adequately substituted hypothyroidism. She did not consume alcohol. She had no macroangiopathic nor microangiopathic complications. She had been suffering, for the last 3 years, from hyperalgesic neuropathic pain with a DN4 score of 7. The pain was in gloves and socks, bilateral, symmetrical and more severe in the upper limbs. As part of the etiological assessment, hypovitaminosis B12 and vitamin D deficiency were screened and treated. Electromyography showed moderate axonal sensory neuropathy of the lower limbs, probably of diabetic origin. The patient was initially started on Pregbalin 600 mg/d, which was later associated with Gabapentin 300 mg/d given the persistence of symptoms. The evolution was marked by a partial improvement despite good compliance with treatment. The patient was referred to a specialized pain centre for further management.

Conclusion: Hyperalgesic diabetic neuropathy rarely affects the upper limbs. It usually responds well to optimal dose of pregabalin. This complication would probably present poorly elucidated mechanisms attested by the case of our patient.