İntravenöz İmmunglobulin Tedavisine Yanıt Veren, Diabetes Mellitus'ta Kronik İnflamatuvar Demiyelinizan Polinöropati; Olgu Sunumu

Öz

Kronik inflamatuvar demiyelinizan polinöropati (CIDP) tedavi yaklaşımları farklı, tedavide immunmodülatör yöntemler kullanılan ve uygulanan tedavi yöntemlerine diğer periferal nöropati formlarından daha iyi yanıt veren bir hastalıktır. Bu makalede 68 yaşında olan 16 yıldır tip 2 Diabetes mellitus tanılı bir bayan olguda CIDP varlığını ortaya koyduk. Tedavi amacıyla IVIG 0.5 mg/kg/gün 5 gün süre ile 4 hafta aralıkla 6 ay uygulandı ve oldukça iyi yanıt gözlendi. Bu hasta diyabetik nöropatik ağrısı olan ve konvansiyonel tedavilere yanıt alınamayan bireylerde otoimmun nöropatilerin unutulmaması gerektiğini göstermiştir. ©2006, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• Diabetes mellitus, kronik inflamatuvar demiyelinizan polinöropati

Chronic Inflammatory Demyelinating Polyneuropathy With Diabetes Mellitus Is Responsive To Intravenous Immune Globulin; Case Report

Abstract

Chronic demyelinating polyneuropathy (CIDP) is a disease which has different treatment modality like immunomodulatory method and have good response to treatment than the other peripheral neuropathy. We have established a patient with CIDP female 68 years old and had a type 2 diabetes mellitus diagnosis for 16 years. She treated with intravenous immunoglobuline (0.5 mg/kg/day) for five days and four weeks intervals at six months. This case has showed that the autoimmune neuropathy should keep in mind at patients with neuropathic pains with not responsive to conventional treatment modalities. ©2006, Fırat Üniversitesi, Tıp Fakültesi

Keywords

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Kaynakça

1. Alber JW,Kelly JJ. Acquired inflammatory demyelinating polyneuropathies; clinical and electrodiagnostic features. Muscle Nerve 1998; 12: 435-51.
2. Saperstein DS, Katz JS, Amato AA, Barohn RJ. Clinical spectrum of chronic acquired demyelinating polyneuropathies. Muscle Nevre 2001; 24;311-24.
3. Wilson JR, Park Y, Fisher MA. Electrodiagnostic criteria in CIDP; comparison with diabetic neuropathy. Electromyogr. Clin. Neurophys. 2000: 40; 182-5.
4. Hattori N, Misu K, Koike H, Ichimura M, Nagamatsu M, Hirayama M, Sobue G. Age of onset influences clinical features of choronic inflamatory demyelinating polyneuropathy. J Neurol Sci. 2001: 184; 57-63.
5. Sharma KR, Cross J, Farronay O, Ayar DR, Shebert RJ, Bradley WG. Demyelinating neuropathy in diabetes mellitus. Arch Neurol. 2002; 59: 758-65.
6. Chin RL, Sherman WH, Sander HW, Hays AP,Latov N. Etanercept therapy for chronic inflammatory demyelinating polyneuropathy. J Neurol Sci. 2003: 210; 19-21.
7. Rotta FT, Sussman AT, Bradley WG, Ayyar DR, Sharma KR, Shebert RT. The spectrum of chronic inflammatory demyelinating polyneuropathy. J Neurol Sci. 2000: 173; 129-39.
8. Haq RU, Pendlebury WW, Fries TJ, Tandan R. Chronic inflammatory demyelinating polyradiculoneuropathy in diabetic patients. Muscle Nerve 2003; 27: 465-70.

9. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care 1998: 21; 1414-31.
10. Hahn AF. Treatment of chronic inflammatory demyelinating polyneuropathy with intravenous immunoglobulin. Neurology 1998; 51: 16-21.
11. Cocito D, Ciaramitaro P, Isoardo G, et al. Intravenous immunoglobulin as first treatment in diabetics with concomitant distal symmetric axonal polyneuropathy and CIDP. J Neurol. 2002: 249;719-22.
12. Lozeron P, Nahum L, Lacroix C, Ropert A, Guiglielmi JM, Said G. Symptomatic diabetic and non-diabetic neuropathies in series of 100 diabetic patients. J Neurol. 1994; 127; 170-8.
13. Uncini A, De Angelis MV, Di Muzio A, et al. Chronic inflammatory demyelinating polyneuropathy in diabetics; motor conductions are important in differantial diagnosis with diabetic polyneuropathy. Clin Neurophysiol 1999: 110; 705-11.
14. Yu Z, Lennon VA. Mechanısm of ıntravenous immune globulin therapy in antibody mediated autoimmune diseases. N Eng J Med. 1999; 340: 227-8.
15. Mendell JR, Barohn RJ, Freimer ML, et al. Working Group on Peripheral Neuropathy. Randomized controlled trial of IVIg in untreated chronic inflammatory demyelinating polyradiculo- neuropathy. Neurology. 2001: 56: 445-9.
16. Kabul Tarihi: 28.02.2006