- Peripheral neuropathy is a feature of many systemic diseases.
- Clinical neurological examination with nerve conduction studies provides the best pathway for reaching a
. . . [Full text of this article]
Postgraduate Medical Journal 2003;79:480-481; doi:10.1136/pmj.79.934.480-a
© 2003 BMJ Publishing Group Ltd and The Fellowship of Postgraduate Medicine.
Postgraduate Medical Journal 2003;79:480-481
© 2003 Fellowship of Postgraduate Medicine
© 2003 Fellowship of Postgraduate Medicine
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An unusual cause of peripheral neuropathy in a diabetic patient on dialysis: "a sural surprise"
| The first 150 words of the full text of this article appear below. |
Q1: What were these two diagnostic procedures?
A liver biopsy and a sural nerve biopsy (fig 1).
A transjugular liver biopsy specimen disclosed granulomatous hepatitis with well defined epithelioid granulomata, with no caseation, throughout the parenchyma and in portal tracts, but negative for fungi, acid-fast bacilli, and with no polarisable material.
The sural nerve biopsy disclosed epineurium intensely infiltrated with monocytic cells in a perivascular distribution and mononuclear cells diffusely in the endoneurium. All fascicles showed uniform severe deletion of myelinated fibres, but demyelinated axons were not seen. The conclusion was that this represented severe acute on chronic axonal degeneration.
Q2: What is the underlying diagnosis?
The mediastinal lymphadenopathy, granulomatous hepatitis, hypercalcaemia, nerve biopsy findings consistent with axonal (sarcoid) neuropathy and the raised serum angiotensin converting enzyme (SACE) level all were consistent with the unifying diagnosis of sarcoidosis.
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- An unusual cause of peripheral neuropathy in a diabetic patient on dialysis: "a sural surprise"
- A Slack, D J A Goldsmith
Postgrad. Med. J. 2003 79: 477.[Extract] [Full Text] [PDF]
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