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Riyadh Ali Mohammed Hammamy, Mohamed Khalid Ahmed Shariff, Mohamed Ghamoodi, Abdelraouf Akkari
(Department of Internal Medicine, Hamad General Corporation, Dohaa, Qatar)
Med Sci Case Rep 2015; 2:44-47
Diabetic patients can present with heterogeneous neuropathies, including sensory, motor, and autonomic neuropathies, but the possibility of non-diabetic neuropathy can be raised in diabetics if neuropathy is atypical, not responding to usual treatment, and when motor involvement is more predominant than sensory system involvement. However, Guillain-Barré syndrome (GBS) is one of the neuropathic diseases to consider whenever acute symmetrical motor nerves have been affected more than sensory nerves in the setting of diabetic neuropathy.
CASE REPORT: We report the case of a 31-year-old man with diabetes mellitus who presented with hyperglycemic symptoms (polyuria, polydipsia, and weight loss) and generalized weakness of both extremities. He was emaciated and severely dehydrated. His biochemical lab tests showed uncontrolled diabetes with serum glucose of 27.4 mmol/L and HbA1C of 15.3% with negative ketones. He was admitted to our hospital to control his glucose and for rehydration.
His glycemic status was stabilized but the weakness in his limbs became aggravated. He was subsequently diagnosed with GBS and managed with immunoglobulins, with remarkable improvement.
CONCLUSIONS: Atypical neuropathy in the background of diabetes mellitus should raise the concern for a differential diagnosis beyond diabetic neuropathy based on appropriate history, examination, and investigation.
Misdiagnosis and incorrect management may increase the morbidity and mortality as a result of the delay in diagnosis, especially in patients with Guillain-Barré syndrome.