A 57 year old man presents with persistent burning pain and altered sensation in the right chest and abdomen for 3 months. During the same time period, he also experienced weakness of the right lower limb, and bulging out of the right abdomen after large meals. He was diagnosed with diabetes 3 years ago, but defaulted on treatment. He is not on any drugs currently, including over the counter medications and herbal remedies. His surgical and family histories are unremarkable. There is no history of contact with tuberculosis. A complete blood count, ESR, CRP, biochemical profile and toxicology screen are normal. His HbA1c level is 8.9%
The ultrasound scan of the abdomen is completely normal.
The contrast MRI of the cervical, dorsal, and lumbosacral spine only reveals mild cervical canal stenosis at the C3 to C6 levels.
Appearance: clear WBC: 2/mm3 (0 - 5) Protein: 59 mg/dL (18-58) Glucose: 200 mg/dL Gram stain and culture: Negative
Nerve conduction velocity studies (NCV) show reduced right femoral compound muscle action potential (CMAP) amplitudes. Concomitant paraspinal electromyography (EMG) reveals denervation potentials in the thoracic and lumbar segments.