Diabetic thoracic radiculopathy: a case of a young woman with clinical improvement following immunotherapy

Abstract

Thoracic radiculopathy is a rare cause of thoracic-abdominal or abdominal pain in subjects with poorly controlled diabetes. We present a case of a young woman with type I diabetes and a severe abdominal pain in both lower quadrants. An extensive diagnostic gastroenterological and gynaecological workup did not disclose abnormalities. Electromyography revealed an initial polyneuropathy and significant neurogenic abnormalities in the T10-T12 paravertebral muscles. Following the hypothesis that the radiculopathy-related abdominal pain might have an immuno-mediated pathogenesis, the patient underwent a complex trial of immunotherapy, which was accompanied by a sustained improvement over months to full recovery. This report would support the hypothesis that immune-mediated mechanisms are still active even months after onset of symptoms.

Keywords: diabetes; neurology (drugs and medicines); pain; peripheral nerve disease.

Figure 1

(A) Vignette showing the distribution of the abdominal pain (lower quadrants, pale blue) with pin-prick hypoaesthesia. (B) Electromyography (EMG) of the paraspinal muscles at the time of diagnosis (T1) and 4 months (T10) after the start with azathioprine (AZA) therapy. (C) Diagram of the clinical evolution of the abdominal pain (scored Numerical Pain Rating Scale (NPRS) on a 1–10 scale) in relation to the intravenous immunoglobulin (IVIg) cycles and azathioprine therapy. Triangles correspond to pain evaluation. Triangle at −1T denotes no pain before the clinical onset (1T). Figure 1A was drawn by VLB. PSW, positive sharp waves.