GATHER THE DATA
Patient photo
Profiles are not of actual patients.
Patient history and presentation
  • 42-year-old Portuguese American male
  • Type 2 diabetes diagnosed 4 years ago, treated with metformin
  • Mother died of heart failure at age 58
  • Loss of balance
  • Initially presented to family physician with numbness, impaired sensation of pain and light touch, and decreased thermal sensation in both feet
  • Frequent diarrhea over the last 2 months, resulting in several missed work days and associated anxiety; treated for 3 urinary tract infections over the last 6 months
  • Referred to neurologist 6 months after initial symptoms due to rapid progression of sensory impairment, weight loss, and development of orthostatic hypotension
  • Neurologic exam reveals:
    • Hypoesthesia up to knee
    • Anesthesia for pinprick and thermal sensation on feet
    • Decreased Achilles tendon reflexes
NEXT...NARROW THE FIELD
WHICH CONDITIONS WOULD YOU CONSIDER
AS PART OF YOUR DIFFERENTIAL DIAGNOSIS?
(Select all that apply)
  • hATTR amyloidosis
  • Diabetic neuropathy
  • Idiopathic polyneuropathy
  • Chronic inflammatory demyelinating polyneuropathy
ENTER SELECTIONS
Test Results from the Case Physician

Thanks for narrowing down the conditions you would consider. In order to continue toward a diagnosis, here are the results of some tests and labs that were ordered by the case physician:

  • Labs: A1C 7.6%, normal hematologic, liver, and renal function
  • Electromyography with nerve conduction studies: Sensory-motor neuropathy, primarily involving lower limbs; bilateral increase in distal motor latencies and absence of F waves in tibial and peroneal nerve assessments
  • Sural nerve biopsy: Congo red positive
MAKE THE CALL Which is the most likely diagnosis?
(Choose one)
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